Individual
DR. JOSHUA DANIEL WIDEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
3986 MARYVILLE RD, GRANITE CITY, IL 62040-4191
(618) 797-0618
Mailing address
3986 MARYVILLE RD, GRANITE CITY, IL 62040-4191
(618) 797-0618
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038.013405
IL
111N00000X
Chiropractor
2017014934
MO
Other
Enumeration date
12/08/2017
Last updated
02/04/2020
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