Healthcare Provider Details

I. General information

NPI: 1659836815
Provider Name (Legal Business Name): JESSICA GRIFFIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2019
Last Update Date: 02/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MCFARLAND BLVD E STE 340
TUSCALOOSA AL
35404-5882
US

IV. Provider business mailing address

104 WARRIOR WAY
AKRON AL
35441-2950
US

V. Phone/Fax

Practice location:
  • Phone: 205-345-8102
  • Fax:
Mailing address:
  • Phone: 317-709-3125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2593
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: