Provider Demographics
NPI:1790478733
Name:SHIFTING TIDES LLC
Entity Type:Organization
Organization Name:SHIFTING TIDES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-519-8698
Mailing Address - Street 1:7 GREENLEAF WOODS DR UNIT 301
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5444
Mailing Address - Country:US
Mailing Address - Phone:413-517-8265
Mailing Address - Fax:
Practice Address - Street 1:7 GREENLEAF WOODS DR UNIT 301
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5444
Practice Address - Country:US
Practice Address - Phone:413-517-8265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty