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Organization

THE REHAB DOCTORS PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CHRISTOPHER T DIETRICH MD (PRESIDENT OF CORPORATION)
(605) 721-7246
Entity
Organization

Contact information

Practice address
1136 JACKSON BLVD, SUITE 3, RAPID CITY, SD 57702-4397
(605) 721-7246
(605) 341-4501
Mailing address
1136 JACKSON BLVD, RAPID CITY, SD 57702-4396
(605) 721-7246
(605) 341-4501

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
5300141945007EUF001
SD
208VP0014X
Interventional Pain Medicine Physician
5300141945007EUT001
SD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0006332
WELLMARK BCBS
SD
01
115322600
WYOMING MEDICAID
SD
01
139018000
OWCP
SD
01
9211582
DAKOTACARE
SD
01
CF8314
RAILROAD MEDICARE
SD
Enumeration date
11/30/2005
Last updated
09/26/2013
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