Provider Demographics
NPI:1932183308
Name:THE REHAB DOCTORS PC
Entity Type:Organization
Organization Name:THE REHAB DOCTORS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:T
Authorized Official - Last Name:DIETRICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-721-7246
Mailing Address - Street 1:1136 JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-4396
Mailing Address - Country:US
Mailing Address - Phone:605-721-7246
Mailing Address - Fax:605-341-4501
Practice Address - Street 1:1136 JACKSON BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-4397
Practice Address - Country:US
Practice Address - Phone:605-721-7246
Practice Address - Fax:605-341-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5300141945007EUF001208100000X
SD5300141945007EUT001208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0006332OtherWELLMARK BCBS
SD9211582OtherDAKOTACARE
SDCF8314OtherRAILROAD MEDICARE
SD139018000OtherOWCP
SD115322600OtherWYOMING MEDICAID
SD139018000OtherOWCP
SDCF8314OtherRAILROAD MEDICARE
SD9211582OtherDAKOTACARE