Gavin Jay Widom, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH0006230 Issued in FL

Practice address

1400 Goodlette Rd N
Naples, FL 34102-5258

Phone

(239) 263-3332

Fax

(239) 262-4780

NPI assigned

Sep 27, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Sonia Kioko Horvath Professional name

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Chiropractic

Education

National College of Chiropractic, 1983

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Widom Chiropractic Offices PA

  • Chiropractor
  • Naples, FL
  • NPI 1558628123
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1699866335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 GOODLETTE RD N",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341025258",
            "telephone_number": "239-263-3332",
            "fax_number": "239-262-4780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 GOODLETTE RD N",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341025258",
            "telephone_number": "239-263-3332",
            "fax_number": "239-262-4780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDOM",
        "first_name": "GAVIN",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH0006230",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SONIA",
            "last_name": "HORVATH",
            "middle_name": "KIOKO",
            "prefix": "MS.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Courtney Lauren Whitt, PH.D.
• Anastasia Whittaker
• Christopher Andrew Widmer, D.D.S.
• Lauren Widmer, DDS
• Widom Chiropractic Offices PA
• Vikki Angert Wiener, D.O.
• Trent Wies
• Scott L Wiesen, MD
• Eric Carl Wiesner, SLP
• Delia Anne Wietecha, MD

• 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 Jul 9, 2007; 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.