Provider Demographics
NPI:1427182104
Name:GRIFFIN, SARA LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:LYNN
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 1:14156 AMARGOSA RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-2417
Mailing Address - Country:US
Mailing Address - Phone:760-955-5558
Mailing Address - Fax:760-241-0449
Practice Address - Street 1:14156 AMARGOSA RD
Practice Address - Street 2:SUITE G
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2417
Practice Address - Country:US
Practice Address - Phone:760-955-5558
Practice Address - Fax:760-241-0449
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-30532111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0305320Medicare PIN