Individual ProviderMichael WidmannChiropractorChiropractic ProvidersPractice Address1674 W Hill Rd, Suite #4, Boise, ID 83702-0958(208) 918-1015PECOS EnrollmentBased on the most recent information from CMS, provider Michael Widmann does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 11:47 AM.Profile DetailsProvider ID1033513973Provider TypeIndividualFull NameWidmann, MichaelCredentialD.C.GenderMaleSole ProprietorNoEnumeration Date10/21/2014Last Updated10/21/2014Contact InformationPractice LocationPractice Address1674 W Hill Rd, Suite #4, Boise, ID 83702-0958Phone(208) 918-1015FaxUnlisted FaxMailing LocationMailing Address1674 W Hill Rd, Suite #4, Boise, ID 83702-0958PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode111N00000XPrimaryDescriptionChiropractorChiropractic ProvidersLicenseCHIA-1586Idaho