Individual
DR. RANDALL SCOTT WIDMAIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
5080 N 40TH ST STE 104, PHOENIX, AZ 85018-2158
(602) 954-6200
(602) 956-1582
Mailing address
5080 N 40TH ST STE 104, PHOENIX, AZ 85018-2158
(602) 954-6200
(602) 956-1582
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4220
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0628191
AETNA HMO
AZ
01
—
1Z3082
HEALTHNET
AZ
05
—
426305 55
—
AZ
01
—
4268552
AETNA
AZ
01
—
818677
APIPA
AZ
01
—
AZ0245320
BLUE CROSS/BLUE SHIELD
AZ
Enumeration date
04/17/2006
Last updated
02/18/2021
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