Provider Demographics
NPI:1043425143
Name:GRIFFIN, TIGE RUSTY (DC)
Entity Type:Individual
Prefix:DR
First Name:TIGE
Middle Name:RUSTY
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:PO BOX 1175
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93447-1175
Mailing Address - Country:US
Mailing Address - Phone:805-239-7797
Mailing Address - Fax:805-227-7177
Practice Address - Street 1:1030 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-5541
Practice Address - Country:US
Practice Address - Phone:805-239-7797
Practice Address - Fax:805-227-7177
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-26867111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC26867Medicare PIN