Provider Demographics
NPI:1487792552
Name:REIMER, JAMES BRADLEY (DC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:BRADLEY
Last Name:REIMER
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 1:646 JENNINGS AVE.
Mailing Address - Street 2:STE #2
Mailing Address - City:HOT SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57747
Mailing Address - Country:US
Mailing Address - Phone:605-745-5017
Mailing Address - Fax:605-745-5017
Practice Address - Street 1:646 JENNINGS AVE.
Practice Address - Street 2:STE #2
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57747
Practice Address - Country:US
Practice Address - Phone:605-745-5017
Practice Address - Fax:605-745-5017
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD863111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0005434OtherBCBS GROUP #
SD0005435OtherBCBS PROVIDER #
SD7604280Medicaid
SDS5435Medicare PIN