Provider Demographics
NPI:1982357257
Name:FRESH START HEALTH, LLC
Entity type:Organization
Organization Name:FRESH START HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FOSTER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CULLUM
Authorized Official - Suffix:IV
Authorized Official - Credentials:DC
Authorized Official - Phone:904-217-7277
Mailing Address - Street 1:425 W TOWN PL STE 104
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3662
Mailing Address - Country:US
Mailing Address - Phone:904-217-7277
Mailing Address - Fax:
Practice Address - Street 1:425 W TOWN PL STE 104
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3662
Practice Address - Country:US
Practice Address - Phone:904-217-7277
Practice Address - Fax:904-217-4668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty