Provider Demographics
NPI:1487419867
Name:ZIMMERMAN, TANNER (DC)
Entity type:Individual
Prefix:DR
First Name:TANNER
Middle Name:
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 1:120 JADE ST UNIT 308
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-8683
Mailing Address - Country:US
Mailing Address - Phone:515-205-6996
Mailing Address - Fax:
Practice Address - Street 1:2721 STANGE RD STE 108
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-3978
Practice Address - Country:US
Practice Address - Phone:515-291-1990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA122783111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor