MEDICARE: HA THI VAN DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	08002521A	IN
2	111N00000X	Chiropractor	CH10183	FL

General Provider Information

NPI Number	:	1124317730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HA THI VAN DC

Provider Business Mailing Address
First Line	:	1656 S VOLUSIA AVE
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-7335
Country	:	US
Telephone Number	:	386-917-0007
Fax Number	:	386-917-0089

Provider Business Practice Location Address
First Line	:	1656 S VOLUSIA AVE
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-7335
Country	:	US
Telephone Number	:	386-917-0007
Fax Number	:	386-917-0089

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2011
Last Update Date	:	07/03/2012

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Directions to “ HA THI VAN DC” Practice Location

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