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General NPI Number Information
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NPI Number | 1932288875
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Entity Type | Individual
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Provider Name | BRIAN KEITH WIDENER DC, RN, CRNA
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Gender | Male
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 03/19/2018
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Provider Practice Location Address
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Address Line | 16000 JOHNSTON MEMORIAL DR
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City | ABINGDON
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State | VA
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Zip | 24211-7664
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Country | US
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Telephone | 276-258-1000
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Fax | 276-258-1405
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Provider Business Mailing Address
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Address Line | 831 SHULER HOLLOW RD
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City | CHILHOWIE
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State | VA
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Zip | 24319-5647
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Country | US
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Telephone | 276-780-2960
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0104555564
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 0024175795
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License Number State | VA
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