Provider Demographics
NPI:1598935306
Name:GRIFFITH LUOMA CHIROPRACTIC
Entity Type:Organization
Organization Name:GRIFFITH LUOMA CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:707-443-0695
Mailing Address - Street 1:2300 MYRTLE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3328
Mailing Address - Country:US
Mailing Address - Phone:707-443-0695
Mailing Address - Fax:707-443-0778
Practice Address - Street 1:2300 MYRTLE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3328
Practice Address - Country:US
Practice Address - Phone:707-443-0695
Practice Address - Fax:707-443-0778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0254450111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ17372ZMedicare PIN