Healthcare Provider Details

I. General information

NPI: 1982126181
Provider Name (Legal Business Name): FREMONT HEALTH SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2017
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 SPIRES LN UNIT 13A
SANTA ROSA BEACH FL
32459
US

IV. Provider business mailing address

56 SPIRES LN UNIT 13A
SANTA ROSA BEACH FL
32459
US

V. Phone/Fax

Practice location:
  • Phone: 850-830-5544
  • Fax: 888-791-3763
Mailing address:
  • Phone: 850-830-5544
  • Fax: 888-791-3763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number60284738
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA JAMES SHIDELES
Title or Position: OWNER/PRESIDENT
Credential: DC
Phone: 850-830-5544