Provider Demographics
NPI:1679791628
Name:SHELLEY REIMER, D.C.
Entity type:Organization
Organization Name:SHELLEY REIMER, D.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:REIMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:617-354-4492
Mailing Address - Street 1:875 MASSACHUSETTS AVE
Mailing Address - Street 2:SUITE 43
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3067
Mailing Address - Country:US
Mailing Address - Phone:617-354-4492
Mailing Address - Fax:617-354-4556
Practice Address - Street 1:875 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE 43
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3067
Practice Address - Country:US
Practice Address - Phone:617-354-4492
Practice Address - Fax:617-354-4556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH1311111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35913Medicare ID - Type UnspecifiedNATIONAL HERITAGE INS. CO
MAY39312Medicare UPIN
MA716867Medicare UPIN
MA35034Medicare UPIN