Rena a. Widboom, PLLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5145 Issued in MN

Legal business name

RENA A. WIDBOOM, PLLC

Doing business as

Encompass Chiropractic

Practice address

13605 27TH Ave N
Plymouth, MN 55441-3616

Phone

(763) 559-5326

NPI assigned

Jun 6, 2013

Last updated

Jun 6, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Rena A Widboom, D.C.NPI 1922252964

Title

Owner/Chiropractor

Phone

(763) 559-5326

Specialties & licenses 1

Addresses

Other names 1

• Encompass Chiropractic Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Rena Ann Widboom, D.C.

  • Chiropractor
  • Minneapolis, MN
  • NPI 1922252964
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1370476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370476800000",
    "number": "1336587864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13605 27TH AVE N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554413616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13605 27TH AVE N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554413616",
            "telephone_number": "763-559-5326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENA A. WIDBOOM, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-06",
        "last_updated": "2013-06-06",
        "status": "A",
        "authorized_official_last_name": "WIDBOOM",
        "authorized_official_first_name": "RENA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/CHIROPRACTOR",
        "authorized_official_telephone_number": "763-559-5326",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "5145",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Encompass Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Chiropractor in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.