Organization
CHIROPRACTIC ACCIDENT AND INJURY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GAVIN JAY WIDOM D.C. (MANAGING PARTNER)
(239) 267-3332
Entity
Organization
Contact information
Practice address
1400 COLONIAL BLVD STE 31, FORT MYERS, FL 33907-1053
(230) 267-3332
Mailing address
1400 COLONIAL BLVD, FORT MYERS, FL 33907-1055
(239) 267-3332
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CH6230
FL
Other
Enumeration date
12/29/2009
Last updated
12/29/2009
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