Provider Demographics
NPI:1023786571
Name:BRANCH, TIANA (DC)
Entity type:Individual
Prefix:DR
First Name:TIANA
Middle Name:
Last Name:BRANCH
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 1:100 BLUE MOON XING STE 103
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-9809
Mailing Address - Country:US
Mailing Address - Phone:470-957-1744
Mailing Address - Fax:
Practice Address - Street 1:100 BLUE MOON XING STE 103
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-9809
Practice Address - Country:US
Practice Address - Phone:470-957-1744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010496111NI0013X, 111NP0017X, 111NR0200X, 111NR0400X, 111NS0005X, 111NX0800X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111NR0200XChiropractic ProvidersChiropractorRadiology
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NX0800XChiropractic ProvidersChiropractorOrthopedic