Provider Demographics
NPI:1023130143
Name:ZIMMERMAN, KRISTI LEA (DC)
Entity type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:LEA
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15556 FLYBOAT LN
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-6021
Mailing Address - Country:US
Mailing Address - Phone:612-382-6343
Mailing Address - Fax:
Practice Address - Street 1:2751 HENNEPIN AVE
Practice Address - Street 2:SUITE 311
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-1002
Practice Address - Country:US
Practice Address - Phone:612-382-6343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4611111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor