Provider Demographics
NPI:1629097969
Name:GRIFFIN, KRISTA BRACKETT (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:BRACKETT
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KRISTA
Other - Middle Name:LYNN
Other - Last Name:BRACKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:110 ANGLERS RD
Mailing Address - Street 2:UNIT #101
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1105
Mailing Address - Country:US
Mailing Address - Phone:302-644-8494
Mailing Address - Fax:302-644-8495
Practice Address - Street 1:110 ANGLERS RD
Practice Address - Street 2:UNIT #101
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1105
Practice Address - Country:US
Practice Address - Phone:302-644-8494
Practice Address - Fax:302-644-8495
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000673111N00000X
PADC 007804111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA913066OtherHIGHMARK ID NUMBER
PADC007804OtherLICENSE NUMBER
DEF1 0000673OtherSTATE LICENCE
DEF1 0000673OtherSTATE LICENCE