Active NPI
Joshua Daniel Wideman, DC
- Chiropractor
- Granite City, IL
National Provider Identifier
1578078838
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 038.013405
- Practice address
- 3986 Maryville Rd
Granite City, IL 62040-4191 - Phone
- (618) 797-0618
- NPI assigned
- Dec 8, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2017014934 | MO | |
| Chiropractor | 111N00000X | 038.013405 | IL | Primary |
Addresses
Primary practice location
3986 Maryville Rd
Granite City, IL 62040-4191
Mailing address
3986 Maryville Rd
Granite City, IL 62040-4191
Phone (618) 797-0618
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2017014934 | MO | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1512691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580774400000",
"number": "1578078838",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3986 MARYVILLE RD",
"city": "GRANITE CITY",
"state": "IL",
"postal_code": "620404191",
"telephone_number": "618-797-0618"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3986 MARYVILLE RD",
"city": "GRANITE CITY",
"state": "IL",
"postal_code": "620404191",
"telephone_number": "618-797-0618"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIDEMAN",
"first_name": "JOSHUA",
"middle_name": "DANIEL",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-12-08",
"last_updated": "2020-02-04",
"certification_date": "2020-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MO",
"license": "2017014934",
"primary": false
},
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "IL",
"license": "038.013405",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Granite City, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.