Abraham W Widjaja, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

7123 Issued in MN

Practice address

2201 Hennepin Ave
Minneapolis, MN 55405-2738

Phone

(612) 377-7760

NPI assigned

Jul 24, 2023

Last updated

May 16, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Chiropractic

Education

Northwestern College of Chiropractic, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Uptown Natural Care Center PAGroup PAC ID 7517947211, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: abraham.widjaja.1@29676.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Uptown Natural Care Center, P.a.

  • Chiropractor
  • Minneapolis, MN
  • NPI 1366597320
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1690156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715817600000",
    "number": "1487334454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1770 BRYANT AVE S APT 201",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554033140",
            "telephone_number": "712-212-1236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 HENNEPIN AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554052738",
            "telephone_number": "612-377-7760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDJAJA",
        "first_name": "ABRAHAM",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-24",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "7123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Wicks, PSY.D., LP
• Lisa A Wicktor, MA CCC SLP
• Kristine Widboom, PHARM.D.
• Rena Ann Widboom, D.C.
• Alik Sunil Widge, M.D., PH.D.
• Kathleen Ann Widmer, APRN, CNP
• Isaac Rolstad Wieber, DPT
• David A Wiechmann, MD
• Anne Bohman Wieck, DNP, APRN
• Tammy Wieczorek, RN

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.