Provider Demographics
NPI:1811649890
Name:DE LA CRUZ, BEVERLY AMANDA (DC)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:AMANDA
Last Name:DE LA CRUZ
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 1:3850 W NORTHWEST HWY APT 3008
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-5225
Mailing Address - Country:US
Mailing Address - Phone:512-669-0157
Mailing Address - Fax:
Practice Address - Street 1:3850 W NORTHWEST HWY APT 3008
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-5225
Practice Address - Country:US
Practice Address - Phone:512-669-0157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14540111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor