Provider Demographics
NPI:1366421646
Name:ZIMMERMAN, JOHN H (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3218
Mailing Address - Country:US
Mailing Address - Phone:970-482-7800
Mailing Address - Fax:970-482-7802
Practice Address - Street 1:1217 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3218
Practice Address - Country:US
Practice Address - Phone:970-482-7800
Practice Address - Fax:970-482-7802
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2258111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
799309OtherFIRST HEALTH PROVIDER #
COZI173068OtherBCBS PROVIDER #
CO611698OtherACN PROVIDER NUMBER
COC807931Medicare PIN