Joanna Wenas Widjaja, DC
Individual provider Active NPI Chiropractor · Sergeant Bluff, IA
NPI 1639909682 · NPPES record last updated Sep 20, 2024
Key facts
- NPI
- 1639909682
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 125921 (IA)
- Practice address
- 204 1St St Ste 111
Sergeant Bluff, IA 51054-8532 - Phone
- (712) 301-7537
- NPI assigned
- Aug 5, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250428001939 | IA | Practitioner - Chiropractic | 6608392246 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125921 | IA | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jiwa Chiropractic & Wellness | Chiropractor | Current |
Accepting new patients |
Locations
204 1st St
Ste 111
Sergeant Bluff, IA 51054
Phone (712) 301-7537
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 125921 | IA | Yes |
Addresses
Primary practice location
204 1St St Ste 111
Sergeant Bluff, IA 51054-8532
Mailing address
204 1St St Ste 111
Sergeant Bluff, IA 51054-8532
Phone (712) 823-3127
Other providers in Sergeant Bluff, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.