Provider Demographics
NPI:1821336728
Name:SHIDELER, JOSHUA JAMES (DC)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:JAMES
Last Name:SHIDELER
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 1:56 SPIRES LN
Mailing Address - Street 2:UNITE 13A
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459
Mailing Address - Country:US
Mailing Address - Phone:850-830-5544
Mailing Address - Fax:888-791-3763
Practice Address - Street 1:56 SPIRES LN
Practice Address - Street 2:UNITE 13A
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459
Practice Address - Country:US
Practice Address - Phone:850-830-5544
Practice Address - Fax:888-791-3763
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60330707111N00000X
FLCH13477111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor