Provider Demographics
NPI:1124426267
Name:BIFSHA FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:BIFSHA FAMILY CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IVI
Authorized Official - Middle Name:
Authorized Official - Last Name:BIFSHA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-930-3696
Mailing Address - Street 1:425 S AVALON PARK BLVD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-6998
Mailing Address - Country:US
Mailing Address - Phone:407-930-3696
Mailing Address - Fax:407-930-3697
Practice Address - Street 1:425 S AVALON PARK BLVD
Practice Address - Street 2:SUITE 1000
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-6998
Practice Address - Country:US
Practice Address - Phone:407-930-3696
Practice Address - Fax:407-930-3697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11363111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty