Provider Demographics
NPI:1447315569
Name:GRIFFIN, HOWARD REGINALD III (DC)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:REGINALD
Last Name:GRIFFIN
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:REGGIE
Other - Middle Name:
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:723 COVE PARKWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326
Mailing Address - Country:US
Mailing Address - Phone:928-204-1590
Mailing Address - Fax:928-204-1590
Practice Address - Street 1:723 COVE PARKWAY
Practice Address - Street 2:SUITE B
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326
Practice Address - Country:US
Practice Address - Phone:928-204-1590
Practice Address - Fax:928-204-1590
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5190111N00000X
CO5800111N00000X
CA21987111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZDC5190Medicare ID - Type Unspecified