Provider Demographics
NPI:1104854629
Name:SHIELDS INFINITY HOLISTIC HEALTH INC.
Entity Type:Organization
Organization Name:SHIELDS INFINITY HOLISTIC HEALTH INC.
Other - Org Name:INTEGRATIVE WELLNESS CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-520-2747
Mailing Address - Street 1:24430 BETHANY WAY
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2820
Mailing Address - Country:US
Mailing Address - Phone:734-779-1650
Mailing Address - Fax:734-769-1650
Practice Address - Street 1:39111 6 MILE RD
Practice Address - Street 2:SUITE 160
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3926
Practice Address - Country:US
Practice Address - Phone:734-779-1650
Practice Address - Fax:734-769-1650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7134Medicare ID - Type Unspecified