Provider Demographics
NPI:1730446212
Name:GRISWOLD FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:GRISWOLD FAMILY CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:TAVERNEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:860-376-4700
Mailing Address - Street 1:141A BROWN AVE
Mailing Address - Street 2:
Mailing Address - City:JEWETT CITY
Mailing Address - State:CT
Mailing Address - Zip Code:06351-1927
Mailing Address - Country:US
Mailing Address - Phone:860-376-4700
Mailing Address - Fax:860-376-4708
Practice Address - Street 1:141A BROWN AVE
Practice Address - Street 2:
Practice Address - City:JEWETT CITY
Practice Address - State:CT
Practice Address - Zip Code:06351-1927
Practice Address - Country:US
Practice Address - Phone:860-376-4700
Practice Address - Fax:860-376-4708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1164692067OtherNPI # 1164692067