Provider Demographics
NPI:1770966186
Name:GREEN, TAUSHLEA KRINA (DC)
Entity type:Individual
Prefix:DR
First Name:TAUSHLEA
Middle Name:KRINA
Last Name:GREEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:TAUSHLEA
Other - Middle Name:KRINA
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:120 LETOURNEAU CIRCLE
Mailing Address - Street 2:BLDG 90311
Mailing Address - City:HURLBURT FIELD
Mailing Address - State:FL
Mailing Address - Zip Code:32544
Mailing Address - Country:US
Mailing Address - Phone:850-881-5240
Mailing Address - Fax:
Practice Address - Street 1:692 NORTHERN AVE
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021-1914
Practice Address - Country:US
Practice Address - Phone:678-842-4378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009496111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor