Victoria Widjaja, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH11707 Issued in FL

Practice address

3500 N State Road 7 Ste 480
Lauderdale Lakes, FL 33319-5600

Phone

(754) 215-6502

NPI assigned

Jan 4, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1451865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453420800000",
    "number": "1851757033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 770970",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "330770970",
            "telephone_number": "754-215-6502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 N STATE ROAD 7 STE 480",
            "city": "LAUDERDALE LAKES",
            "state": "FL",
            "postal_code": "333195600",
            "telephone_number": "754-215-6502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDJAJA",
        "first_name": "VICTORIA",
        "name_prefix": "Ms.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-04",
        "last_updated": "2016-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH11707",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CH33319",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• West Broward Kidney, PA
• West Broward Nephrology PA
• Ingrid S Whitbourne-Cooke, O.D.
• Yassecha Akela White, BCBA
• Ebony Sheena Whitfleld
• Hazel Wiley, D.O
• Ashley Williams
• Khari Williams, BCBA
• Virone Williams, RN
• Nneka Wint

• Chiropractor in Lauderdale Lakes, FL
• Providers in Lauderdale Lakes, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.