Provider Demographics
NPI:1417771668
Name:GRIFFIN, RUTH G
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:G
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:EATONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5338
Mailing Address - Country:US
Mailing Address - Phone:407-334-6129
Mailing Address - Fax:
Practice Address - Street 1:3301 5TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-1411
Practice Address - Country:US
Practice Address - Phone:407-328-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11164111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor