Provider Demographics
NPI:1982126181
Name:FREMONT HEALTH SOLUTIONS LLC
Entity Type:Organization
Organization Name:FREMONT HEALTH SOLUTIONS LLC
Other - Org Name:THE CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SHIDELES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-830-5544
Mailing Address - Street 1:56 SPIRES LN
Mailing Address - Street 2:UNIT 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:UNIT 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-10
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60284738111N00000X
111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty