Provider Demographics
NPI:1124317730
Name:VAN, HA THI (DC)
Entity type:Individual
Prefix:
First Name:HA
Middle Name:THI
Last Name:VAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1656 S VOLUSIA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7335
Mailing Address - Country:US
Mailing Address - Phone:386-917-0007
Mailing Address - Fax:386-917-0089
Practice Address - Street 1:1656 S VOLUSIA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7335
Practice Address - Country:US
Practice Address - Phone:386-917-0007
Practice Address - Fax:386-917-0089
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002521A111N00000X
FLCH10183111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor