1548268816 NPI number — DR. RYAN JOHN ROBERT GRIFFIN D.C.

Table of content: DR. RYAN JOHN ROBERT GRIFFIN D.C. (NPI 1548268816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548268816 NPI number — DR. RYAN JOHN ROBERT GRIFFIN D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRIFFIN
Provider First Name:
RYAN
Provider Middle Name:
JOHN ROBERT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548268816
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
539 ROSCOE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH BELOIT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61080-1910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-703-7259
Provider Business Mailing Address Fax Number:
815-623-8674

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5508 CLAYTON CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSCOE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61073-9533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-623-6534
Provider Business Practice Location Address Fax Number:
815-623-8674
Provider Enumeration Date:
07/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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