Healthcare Provider Details

I. General information

NPI: 1174575088
Provider Name (Legal Business Name): PINES TOTAL HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 MADRUGA AVE STE 402
CORAL GABLES FL
33146-3165
US

IV. Provider business mailing address

1450 MADRUGA AVE STE 402
CORAL GABLES FL
33146-3165
US

V. Phone/Fax

Practice location:
  • Phone: 786-401-7214
  • Fax: 786-391-0275
Mailing address:
  • Phone: 786-401-7214
  • Fax: 786-391-0275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID L HIRSCHENSON
Title or Position: PRESIDENT
Credential: DC
Phone: 786-401-7214