Provider Demographics
NPI:1891943353
Name:RIEMER, KENNETH SHANE (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:SHANE
Last Name:RIEMER
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 1:8201 SW 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79121-1062
Mailing Address - Country:US
Mailing Address - Phone:806-359-4360
Mailing Address - Fax:806-359-4367
Practice Address - Street 1:8201 SW 34TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79121-1062
Practice Address - Country:US
Practice Address - Phone:806-359-4360
Practice Address - Fax:806-359-4367
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9092111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200001947OtherEIN
TX609729Medicare PIN