Provider Demographics
NPI:1316147309
Name:GRIFFIN, DONALD W
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:W
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:DONALD
Other - Middle Name:W
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 11235
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-0235
Mailing Address - Country:US
Mailing Address - Phone:215-242-1890
Mailing Address - Fax:215-242-2692
Practice Address - Street 1:1508 E WADSWORTH AVE
Practice Address - Street 2:2C
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-1616
Practice Address - Country:US
Practice Address - Phone:215-242-1890
Practice Address - Fax:215-242-2692
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004757-L111N00000X
PADC004757L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0125567701Medicaid