Provider Demographics
NPI:1396727582
Name:ZIMMER, MICHAEL C (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:ZIMMER
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 1:11705 DORSETT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-2519
Mailing Address - Country:US
Mailing Address - Phone:314-291-3666
Mailing Address - Fax:314-291-3668
Practice Address - Street 1:11705 DORSETT RD STE 101
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-2519
Practice Address - Country:US
Practice Address - Phone:314-291-3666
Practice Address - Fax:314-291-3668
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE003583111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT42956Medicare UPIN
MO14378Medicare UPIN