Individual provider Active NPI

John Matt Griswold, D.C.

  • Chiropractor
  • Tulsa, OK
National Provider Identifier
1407120199
Registry record updated Oct 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4059 Issued in OK
Practice address
702 S Utica Ave
Tulsa, OK 74104-3213
Phone
(918) 212-8688
Fax
(866) 352-5122
NPI assigned
Feb 28, 2012
Last updated
Oct 22, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 22, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 4059 OK Primary

Addresses

Primary practice location

702 S Utica Ave
Tulsa, OK 74104-3213

Mailing address

702 S Utica Ave
Tulsa, OK 74104-3213
Phone (918) 212-8688

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120905000585 OK Practitioner - Chiropractic 3870740392 Reassigns benefits to 1 organization
Practice locations: Tulsa, OK

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College, 2011
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

12150 E 96TH St N
Suite 100
Owasso, OK 74055-5339

702 S Utica Ave
Tulsa, OK 74104-3213
Phone (918) 212-8688

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4059OKMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
918 Chiropractic South Chiropractor CurrentSince Jan 1, 2021 Accepting new patients
918 Chiropractic CurrentSince Jun 15, 2013 Accepting new patients
918 Chiropractic Owasso LLC Chiropractor CurrentSince Dec 3, 2025 Accepting new patients

Locations

12150 E 96th St N
Ste 100
Owasso, OK 74055
Phone (870) 213-7366

1320 E 15th St
Tulsa, OK 74120
Phone (918) 212-8688

702 S Utica Ave
Tulsa, OK 74104
Phone (713) 826-9594

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1330387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761091200000",
    "number": "1407120199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 S UTICA AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741043213",
            "telephone_number": "918-212-8688",
            "fax_number": "866-352-5122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 S UTICA AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741043213",
            "telephone_number": "918-212-8688",
            "fax_number": "866-352-5122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRISWOLD",
        "first_name": "JOHN",
        "middle_name": "MATT",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-02-28",
        "last_updated": "2025-10-22",
        "certification_date": "2025-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OK",
            "license": "4059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.