Provider Demographics
NPI:1659836815
Name:GRIFFIN, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 WARRIOR WAY
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:AL
Mailing Address - Zip Code:35441-2950
Mailing Address - Country:US
Mailing Address - Phone:317-709-3125
Mailing Address - Fax:
Practice Address - Street 1:1800 MCFARLAND BLVD E STE 340
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-5882
Practice Address - Country:US
Practice Address - Phone:205-345-8102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2593111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor