Provider Demographics
NPI:1508135401
Name:GRIFFIN CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:GRIFFIN CHIROPRACTIC CLINIC, INC.
Other - Org Name:GAINESVILLE CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:SR
Authorized Official - Credentials:DC
Authorized Official - Phone:770-532-4084
Mailing Address - Street 1:700 S ENOTA DR NE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2403
Mailing Address - Country:US
Mailing Address - Phone:770-532-4084
Mailing Address - Fax:
Practice Address - Street 1:700 S ENOTA DR NE
Practice Address - Street 2:SUITE 201
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2403
Practice Address - Country:US
Practice Address - Phone:770-532-4084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2451111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCBZLOtherMEDICARE PTAN