Provider Demographics
NPI:1376396390
Name:GRIFFIN, BREANNE S (DC)
Entity Type:Individual
Prefix:DR
First Name:BREANNE
Middle Name:S
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39702-5354
Mailing Address - Country:US
Mailing Address - Phone:662-497-2837
Mailing Address - Fax:
Practice Address - Street 1:601 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702-5354
Practice Address - Country:US
Practice Address - Phone:662-497-2837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1335111N00000X
GACHIR010572111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor