Provider Demographics
NPI:1407082571
Name:COREY, TISHA RENE (DC)
Entity type:Individual
Prefix:DR
First Name:TISHA
Middle Name:RENE
Last Name:COREY
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 1:1376 DUKES CREEK DR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-8231
Mailing Address - Country:US
Mailing Address - Phone:678-522-5575
Mailing Address - Fax:
Practice Address - Street 1:2440 SANDY PLAINS RD
Practice Address - Street 2:BLDG 24 SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-7217
Practice Address - Country:US
Practice Address - Phone:770-866-4075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007784111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor