Provider Demographics
NPI:1598122681
Name:GRIFFIN, ANDREA WHYTE (DC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:WHYTE
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:PO BOX 1589
Mailing Address - Street 2:
Mailing Address - City:EL PRADO
Mailing Address - State:NM
Mailing Address - Zip Code:87529-1589
Mailing Address - Country:US
Mailing Address - Phone:575-776-1117
Mailing Address - Fax:575-776-1119
Practice Address - Street 1:98 ST. HWY 150
Practice Address - Street 2:SUITE 7
Practice Address - City:EL PRADO
Practice Address - State:NM
Practice Address - Zip Code:87529
Practice Address - Country:US
Practice Address - Phone:575-776-1117
Practice Address - Fax:575-776-1119
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2135111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor