Provider Demographics
NPI:1457321770
Name:GRIFFIN, GREGG STEPHEN (DC)
Entity Type:Individual
Prefix:MR
First Name:GREGG
Middle Name:STEPHEN
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 1:819 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:OH
Mailing Address - Zip Code:43410-1215
Mailing Address - Country:US
Mailing Address - Phone:419-547-7787
Mailing Address - Fax:418-547-7787
Practice Address - Street 1:112 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:OH
Practice Address - Zip Code:43410-1540
Practice Address - Country:US
Practice Address - Phone:419-547-7787
Practice Address - Fax:419-547-7787
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0500514Medicaid
T47429Medicare UPIN
OH0500514Medicaid