Provider Demographics
NPI:1265245609
Name:HEREDIA, JOYCE DANIELA (DC)
Entity type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:DANIELA
Last Name:HEREDIA
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 1:3100 RODEO ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76119-4722
Mailing Address - Country:US
Mailing Address - Phone:817-528-7528
Mailing Address - Fax:
Practice Address - Street 1:3017 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103-2925
Practice Address - Country:US
Practice Address - Phone:817-413-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13059111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty