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General NPI Number Information
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NPI Number | 1104854629
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Entity Type | Organization
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Legal Business Name | SHIELDS INFINITY HOLISTIC HEALTH INC.
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 09/20/2012
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Provider Practice Location Address
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Address Line | 39111 6 MILE RD SUITE 160
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City | LIVONIA
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State | MI
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Zip | 48152-3926
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Country | US
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Telephone | 734-779-1650
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Fax | 734-769-1650
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Provider Business Mailing Address
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Address Line | 24430 BETHANY WAY
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City | NOVI
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State | MI
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Zip | 48375-2820
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Country | US
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Telephone | 734-779-1650
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Fax | 734-769-1650
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Authorized Official
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Title or Position | OWNER
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Name | JOSHUA E SHIELDS
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Credential | DC
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Telephone | 678-520-2747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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