Healthcare Provider Details

I. General information

NPI: 1124317730
Provider Name (Legal Business Name): HA THI VAN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 BELLAGIO CIR
SANFORD FL
32771-5001
US

IV. Provider business mailing address

201 BELLAGIO CIR
SANFORD FL
32771-5001
US

V. Phone/Fax

Practice location:
  • Phone: 386-917-0007
  • Fax: 386-917-0089
Mailing address:
  • Phone: 386-917-0007
  • Fax: 386-917-0089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH10183
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: