Provider Demographics
NPI:1619068756
Name:MCGRIFF, KIMBERLY A (DC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:MCGRIFF
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 1:109 RIVER PL
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-4018
Mailing Address - Country:US
Mailing Address - Phone:608-663-8809
Mailing Address - Fax:608-663-8812
Practice Address - Street 1:109 RIVER PL
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-4018
Practice Address - Country:US
Practice Address - Phone:608-663-8809
Practice Address - Fax:608-663-8812
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3214111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0186UOtherBCBSNC GROUP NUMBER
NC085PKOtherBCBSNC
NC890186UMedicaid
NC89085PKMedicaid
NC2453940Medicare ID - Type UnspecifiedGROUP NUMBER
NC2456722Medicare ID - Type Unspecified
NC890186UMedicaid