Provider Demographics
NPI:1811180177
Name:WIDHELM CHIROPRACTIC CLINIC P C
Entity type:Organization
Organization Name:WIDHELM CHIROPRACTIC CLINIC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:WIDHELM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-463-6797
Mailing Address - Street 1:2727 W 2ND ST
Mailing Address - Street 2:STE 322
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-4684
Mailing Address - Country:US
Mailing Address - Phone:402-463-6797
Mailing Address - Fax:402-463-6701
Practice Address - Street 1:2727 W 2ND ST
Practice Address - Street 2:STE 322
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-4684
Practice Address - Country:US
Practice Address - Phone:402-463-6797
Practice Address - Fax:402-463-6701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE767111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========-00Medicaid
NE900002Medicare PIN
NET40192Medicare UPIN