Provider Demographics
NPI:1548914930
Name:LUNA, DEZERE DENISE (DC)
Entity type:Individual
Prefix:
First Name:DEZERE
Middle Name:DENISE
Last Name:LUNA
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 1:1900 N BECKLEY AVE APT 3053
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-2352
Mailing Address - Country:US
Mailing Address - Phone:620-255-9211
Mailing Address - Fax:
Practice Address - Street 1:3334 N TOWN EAST BLVD STE 102
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-3800
Practice Address - Country:US
Practice Address - Phone:972-681-8321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15059111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor