Provider Demographics
NPI:1841707312
Name:SHIFTING TIDES CHIROPRACTIC LLC
Entity type:Organization
Organization Name:SHIFTING TIDES CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-722-5454
Mailing Address - Street 1:1403 APPLETON RD
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1101
Mailing Address - Country:US
Mailing Address - Phone:920-722-5454
Mailing Address - Fax:
Practice Address - Street 1:1403 APPLETON RD
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1101
Practice Address - Country:US
Practice Address - Phone:920-722-5454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-05
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5315-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty