Provider Demographics
NPI:1174558340
Name:GRIFFIN, JOHN A (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WEST AVE J
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-3684
Mailing Address - Country:US
Mailing Address - Phone:661-723-3132
Mailing Address - Fax:661-723-1982
Practice Address - Street 1:210 WEST AVE J
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3684
Practice Address - Country:US
Practice Address - Phone:661-723-3132
Practice Address - Fax:661-723-1982
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19136111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC19136Medicare PIN