Provider Demographics
NPI:1215035381
Name:GRIFFIN, GREGORY ANTHONY JR (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ANTHONY
Last Name:GRIFFIN
Suffix:JR
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 542051
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75354-2051
Mailing Address - Country:US
Mailing Address - Phone:214-274-3893
Mailing Address - Fax:
Practice Address - Street 1:8225 BRUTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-1903
Practice Address - Country:US
Practice Address - Phone:214-275-7200
Practice Address - Fax:214-388-1112
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10229111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV08799Medicare UPIN
TX8F2707Medicare ID - Type Unspecified