MEDICARE: IVI BIFSHA 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	CH11363	FL

General Provider Information

NPI Number	:	1710494240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVI BIFSHA DC

Provider Business Mailing Address
First Line	:	425 S AVALON PARK BLVD STE 1000
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-6703
Country	:	US
Telephone Number	:	407-930-3696
Fax Number	:	407-930-3697

Provider Business Practice Location Address
First Line	:	425 S AVALON PARK BLVD STE 1000
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-6703
Country	:	US
Telephone Number	:	407-930-3696
Fax Number	:	407-930-3697

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

Provider Enumeration Date	:	01/05/2018
Last Update Date	:	04/06/2026

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Directions to “ IVI BIFSHA DC” Practice Location

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