Organization
LARRY F WIDMER DC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY F WIDMER DC (PRESIDENT)
(717) 368-4016
Entity
Organization
Contact information
Practice address
1892 PLAZA DEL SUR DR STE A, SANTA FE, NM 87505-6073
(505) 988-8017
(505) 988-8018
Mailing address
1892 PLAZA DEL SUR DR STE A, SANTA FE, NM 87505-6073
(505) 988-8017
(505) 988-8018
Taxonomy
Speciality
Code
Description
License number
State
111NX0800X
Orthopedic Chiropractor
Primary
1406
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
035313F70
MEDICARE NUMBER
—
Enumeration date
02/22/2015
Last updated
02/22/2015
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