# BOULDER HEADACHE AND PAIN PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114432903
- **Authorized official:** ALEX G REISH DO (OWNER)
- **Authorized official phone:** (303) 225-6625

## Contact information

- **Practice address:** 5377 MANHATTAN CIR STE 200, BOULDER, CO 80303-4345
- **Practice address phone:** (303) 225-6625
- **Practice address fax:** (303) 225-6626
- **Mailing address:** 5377 MANHATTAN CIR STE 200, BOULDER, CO 80303-4345
- **Mailing address phone:** (303) 225-6625

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204D00000X | Neuromusculoskeletal Medicine & OMM Physician | 46517 | CO | Yes |
| 207Q00000X | Family Medicine Physician | 46517 | CO | — |

## Other

- **Enumeration date:** 12/04/2017
- **Last updated:** 09/19/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 62451383 | — | CO |