Healthcare Provider Details

I. General information

NPI: 1396260964
Provider Name (Legal Business Name): MARSHALL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 06/18/2022
Certification Date: 06/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 NE MIAMI GARDENS DR STE 264
NORTH MIAMI BEACH FL
33179-4721
US

IV. Provider business mailing address

1380 NE MIAMI GARDENS DR STE 264
NORTH MIAMI BEACH FL
33179-4721
US

V. Phone/Fax

Practice location:
  • Phone: 305-587-5599
  • Fax: 305-675-5797
Mailing address:
  • Phone: 305-587-5599
  • Fax: 305-675-5797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GUSTAVO H MARSHALL JR.
Title or Position: PRESIDENT
Credential: DC
Phone: 305-587-5599