Healthcare Provider Details

I. General information

NPI: 1912693938
Provider Name (Legal Business Name): BYRON IAN HOFFMAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 SE HILLMOOR DR
PORT SAINT LUCIE FL
34952-7539
US

IV. Provider business mailing address

2561 SE VICTORY AVE
PORT SAINT LUCIE FL
34952-6776
US

V. Phone/Fax

Practice location:
  • Phone: 772-333-2648
  • Fax: 772-621-5131
Mailing address:
  • Phone: 763-452-5713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number14486
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: