Provider Demographics
NPI:1710392832
Name:ELITE SPINE & SPORT
Entity Type:Organization
Organization Name:ELITE SPINE & SPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:214-274-3893
Mailing Address - Street 1:131 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:VENUS
Mailing Address - State:TX
Mailing Address - Zip Code:76084-3724
Mailing Address - Country:US
Mailing Address - Phone:214-274-3893
Mailing Address - Fax:
Practice Address - Street 1:603 N CEDAR RIDGE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-3198
Practice Address - Country:US
Practice Address - Phone:214-274-3893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10229111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty