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General NPI Number Information
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NPI Number | 1841707312
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Entity Type | Organization
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Legal Business Name | SHIFTING TIDES CHIROPRACTIC LLC
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Dates
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Enumeration Date | 01/05/2018
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Last Update Date | 01/31/2018
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Provider Practice Location Address
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Address Line | 1403 APPLETON RD
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City | MENASHA
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State | WI
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Zip | 54952-1101
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Country | US
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Telephone | 920-722-5454
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Fax |
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Provider Business Mailing Address
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Address Line | 1403 APPLETON RD
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City | MENASHA
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State | WI
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Zip | 54952-1101
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Country | US
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Telephone | 920-722-5454
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. FELICIA HOUK
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Credential | DC
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Telephone | 920-722-5454
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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 | 5315-12
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License Number State | WI
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