Provider Demographics
NPI:1710990213
Name:REIMER, SHELLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:
Last Name:REIMER
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 1:282 MOODY ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-5232
Mailing Address - Country:US
Mailing Address - Phone:781-891-4300
Mailing Address - Fax:
Practice Address - Street 1:282 MOODY ST
Practice Address - Street 2:SUITE 212
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-5219
Practice Address - Country:US
Practice Address - Phone:781-891-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH 1311111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA35034OtherHPHC
MA716867OtherTUFTS HEALTH PLAN
MAY35913Medicare ID - Type UnspecifiedMEDICARE
MA35034OtherHPHC