Widom Chiropractic Offices PA

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH 6230 Issued in FL

Legal business name

WIDOM CHIROPRACTIC OFFICES PA

Practice address

5385 Park Central CT
Naples, FL 34109-5932

Phone

(239) 596-9050

NPI assigned

Apr 19, 2012

Last updated

Oct 22, 2012By 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. Gavin Jay Widom, DCNPI 1699866335

Title

Owner

Phone

(239) 263-3332

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

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.

• Gavin Jay Widom, DC

  • Chiropractor
  • Naples, FL
  • NPI 1699866335
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1334793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350864000000",
    "number": "1558628123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5385 PARK CENTRAL CT",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341095932",
            "telephone_number": "239-596-9050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5385 PARK CENTRAL CT",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341095932",
            "telephone_number": "239-596-9050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WIDOM CHIROPRACTIC OFFICES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-19",
        "last_updated": "2012-10-22",
        "status": "A",
        "authorized_official_last_name": "WIDOM",
        "authorized_official_first_name": "GAVIN",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "239-263-3332",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH 6230",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wesley A Whitright, CRNA
• Courtney Lauren Whitt, PH.D.
• Anastasia Whittaker
• Christopher Andrew Widmer, D.D.S.
• Lauren Widmer, DDS
• Gavin Jay Widom, DC
• Vikki Angert Wiener, D.O.
• Trent Wies
• Scott L Wiesen, MD
• Eric Carl Wiesner, SLP

• Chiropractor in Naples, FL
• Providers in Naples, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.