Provider Demographics
NPI:1609920503
Name:GRIFFIN, LAUREL ANNE (DC)
Entity Type:Individual
Prefix:DR
First Name:LAUREL
Middle Name:ANNE
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 1:2501 WESTOWN PARKWAY
Mailing Address - Street 2:SUITE 1202 1/2
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266
Mailing Address - Country:US
Mailing Address - Phone:515-224-1093
Mailing Address - Fax:515-224-1094
Practice Address - Street 1:2501 WESTOWN PARKWAY
Practice Address - Street 2:SUITE 1202 1/2
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266
Practice Address - Country:US
Practice Address - Phone:515-224-1093
Practice Address - Fax:515-224-1093
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06925111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IADN2889OtherRR MEDICARE
IAI20410OtherMEDICARE PTAN
IADN2889OtherRR MEDICARE