| Widmaier Chiropractic | |
|
5080 N 40th St Ste 104 Phoenix AZ 85018-2158 | |
| (602) 954-6200 | |
| (602) 956-1582 |
| Full Name | Widmaier Chiropractic |
|---|---|
| Speciality | Clinic/Center |
| Location | 5080 N 40th St Ste 104, Phoenix, Arizona |
| Authorized Official Name and Position | Randall S Widmaier (PRESIDENT) |
| Authorized Official Contact | 6029546200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Widmaier Chiropractic 5080 N 40th St Ste 104 Phoenix AZ 85018-2158 Ph: (602) 954-6200 | Widmaier Chiropractic 5080 N 40th St Ste 104 Phoenix AZ 85018-2158 Ph: (602) 954-6200 |
| NPI Number | 1205187689 |
|---|---|
| Provider Enumeration Date | 09/26/2012 |
| Last Update Date | 02/18/2021 |
| Medicare PECOS PAC ID | 5698927176 |
|---|---|
| Medicare Enrollment ID | O20121207000283 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205187689 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 4220 (Arizona) | Primary |
| Provider Name | Randall Scott Widmaier |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1770548554 PECOS PAC ID: 9234020025 Enrollment ID: I20040322001425 |
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