=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497637516
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CODY KRISTOPHER GRIFFIN DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2025
-----------------------------------------------------
Last Update Date | 08/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10945 SUNRISE CIR
-----------------------------------------------------
City | KEITHVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71047-5401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-470-0834
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10945 SUNRISE CIR
-----------------------------------------------------
City | KEITHVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71047-5401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-470-0834
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2052
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------