Provider Demographics
NPI:1518720770
Name:GRIFFIN, MADORI J (DC)
Entity Type:Individual
Prefix:DR
First Name:MADORI
Middle Name:J
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 1:11260 ANACONDA AVE
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-1969
Mailing Address - Country:US
Mailing Address - Phone:760-985-0624
Mailing Address - Fax:
Practice Address - Street 1:14196 AMARGOSA RD STE H
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2429
Practice Address - Country:US
Practice Address - Phone:760-912-3378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36868111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor