Provider Demographics
NPI:1235713892
Name:FROSETH, SHAD (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAD
Middle Name:
Last Name:FROSETH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 20TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-6452
Mailing Address - Country:US
Mailing Address - Phone:701-852-2800
Mailing Address - Fax:
Practice Address - Street 1:1350 20TH AVE SW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-6452
Practice Address - Country:US
Practice Address - Phone:701-852-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDSTUDENT111N00000X
NDNA111N00000X
ND1172111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor