Provider Demographics
NPI:1366459174
Name:MARSHALL, GUSTAVO H (DC)
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:H
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 NE MIAMI GARDENS DR STE 264
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4721
Mailing Address - Country:US
Mailing Address - Phone:305-354-9550
Mailing Address - Fax:305-675-5797
Practice Address - Street 1:1380 NE MIAMI GARDENS DR
Practice Address - Street 2:264
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4707
Practice Address - Country:US
Practice Address - Phone:305-587-5599
Practice Address - Fax:305-675-5797
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8807111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBS412AMedicare PIN
FLBS412AMedicare PIN
714907OtherUNITED HEALTHCARE