Provider Demographics
NPI:1578377636
Name:HERRERA, NATHANIEL TRISTAN (DC)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:TRISTAN
Last Name:HERRERA
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 1:1904 BUFFALO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-3458
Mailing Address - Country:US
Mailing Address - Phone:956-961-7510
Mailing Address - Fax:
Practice Address - Street 1:11550 LEGACY DR STE 480
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-8678
Practice Address - Country:US
Practice Address - Phone:972-377-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16351111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NR0400XChiropractic ProvidersChiropractorRehabilitation