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General NPI Number Information
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NPI Number | 1457640591
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Entity Type | Organization
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Legal Business Name | CORAL GABLES PHYSICIAN CARE LLC
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Dates
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Enumeration Date | 03/29/2011
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Last Update Date | 03/29/2011
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Provider Practice Location Address
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Address Line | 3301 SW 22ND ST SUITE 201
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City | MIAMI
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State | FL
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Zip | 33145-2200
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Country | US
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Telephone | 305-444-1110
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Fax | 305-444-1120
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Provider Business Mailing Address
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Address Line | 3301 SW 22ND ST SUITE 201
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City | MIAMI
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State | FL
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Zip | 33145-2200
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Country | US
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Telephone | 305-444-1110
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Fax | 305-444-1120
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Authorized Official
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Title or Position | MANAGER
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Name | DR. DAVID HIRSCHENSON
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Credential | DC
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Telephone | 305-444-1110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH0004149
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License Number State | FL
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