MEDICARE: DR. BYRON IAN HOFFMAN 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	14486	FL

General Provider Information

NPI Number	:	1912693938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BYRON IAN HOFFMAN DC

Provider Business Mailing Address
First Line	:	2561 SE VICTORY AVE
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-6776
Country	:	US
Telephone Number	:	763-452-5713
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 SE HILLMOOR DR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7539
Country	:	US
Telephone Number	:	772-333-2648
Fax Number	:	772-621-5131

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

Provider Enumeration Date	:	04/13/2023
Last Update Date	:	04/13/2023

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