Provider Demographics
NPI:1679130926
Name:GONZALEZ, THALIA KRYSTAL (DC)
Entity Type:Individual
Prefix:DR
First Name:THALIA
Middle Name:KRYSTAL
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 LAWRENCEVILLE HWY NW STE A
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-4946
Mailing Address - Country:US
Mailing Address - Phone:470-299-5790
Mailing Address - Fax:
Practice Address - Street 1:5005 LAWRENCEVILLE HWY NW
Practice Address - Street 2:STE A
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-4946
Practice Address - Country:US
Practice Address - Phone:470-299-5790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010214111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor