Provider Demographics
NPI:1992125298
Name:GRISWOLD, DONALD ANTHONY (DC,)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ANTHONY
Last Name:GRISWOLD
Suffix:
Gender:M
Credentials:DC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 BEDFORD RD STE B
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6600
Mailing Address - Country:US
Mailing Address - Phone:972-742-4279
Mailing Address - Fax:
Practice Address - Street 1:1117 BEDFORD RD STE B
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6600
Practice Address - Country:US
Practice Address - Phone:972-742-4279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12388111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor