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General NPI Number Information
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NPI Number | 1306193537
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Entity Type | Organization
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Legal Business Name | ERIC WIDHELM LLC
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Dates
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Enumeration Date | 08/07/2012
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 2015 W BROADWAY ST STE 38
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City | ARDMORE
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State | OK
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Zip | 73401-2501
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Country | US
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Telephone | 580-798-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 2015 W BROADWAY ST STE 38
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City | ARDMORE
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State | OK
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Zip | 73401-2501
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Country | US
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Telephone | 580-798-2800
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERIC WIDHELM
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Credential | D.C.
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Telephone | 580-798-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4064
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License Number State | OK
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