Provider Demographics
NPI:1699426130
Name:MOY, HESTON EDUARDO (DC)
Entity type:Individual
Prefix:DR
First Name:HESTON
Middle Name:EDUARDO
Last Name:MOY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 NE 21ST AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5664
Mailing Address - Country:US
Mailing Address - Phone:754-610-0853
Mailing Address - Fax:
Practice Address - Street 1:13220 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2040
Practice Address - Country:US
Practice Address - Phone:754-610-0853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-17
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13658111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor