Provider Demographics
NPI:1679569263
Name:WIMMER, DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:WIMMER
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 1:2203 GRAVES MILL RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-4296
Mailing Address - Country:US
Mailing Address - Phone:434-845-9000
Mailing Address - Fax:434-455-2276
Practice Address - Street 1:2203 GRAVES MILL RD
Practice Address - Street 2:SUITE E
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-4296
Practice Address - Country:US
Practice Address - Phone:434-845-9000
Practice Address - Fax:434-455-2276
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556254111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1799336OtherCIGNA
VA144638OtherANTHEM
VAP00137284OtherRAILROAD MEDICARE
VA00W046W01Medicare ID - Type Unspecified
VA1799336OtherCIGNA