Provider Demographics
NPI:1891424727
Name:WIDEN, ADAM WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:WAYNE
Last Name:WIDEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19141 STONE OAK PKWY STE 506
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3374
Mailing Address - Country:US
Mailing Address - Phone:210-343-5209
Mailing Address - Fax:
Practice Address - Street 1:19141 STONE OAK PKWY STE 506
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3374
Practice Address - Country:US
Practice Address - Phone:210-343-5209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor