Healthcare Provider Details

I. General information

NPI: 1801934989
Provider Name (Legal Business Name): NEUROMUSCULOSKELETAL REHABILITATION AND PAIN CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

646 JENNINGS AVE. STE #2
HOT SPRINGS SD
57747
US

IV. Provider business mailing address

600 W 8TH ST
GILLETTE WY
82716-4107
US

V. Phone/Fax

Practice location:
  • Phone: 605-745-5017
  • Fax: 605-745-5017
Mailing address:
  • Phone: 307-689-6277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number863
License Number StateSD

VIII. Authorized Official

Name: JAMES BRADLEY REIMER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 307-689-6277