Provider Demographics
NPI:1598857518
Name:GRIFFITH, JODI LYNNE (DC)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:LYNNE
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:LYNNE
Other - Last Name:BROVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:BOX 547
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54829
Mailing Address - Country:US
Mailing Address - Phone:715-822-2135
Mailing Address - Fax:715-822-2135
Practice Address - Street 1:1425 2ND AVE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:WI
Practice Address - Zip Code:54829
Practice Address - Country:US
Practice Address - Phone:715-822-2135
Practice Address - Fax:715-822-2135
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3114012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor