Provider Demographics
NPI:1700087103
Name:BRONSTEIN, MARSHALL (DC)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:
Last Name:BRONSTEIN
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 1:16585 NW 2ND AVE
Mailing Address - Street 2:#300
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-6038
Mailing Address - Country:US
Mailing Address - Phone:305-947-7300
Mailing Address - Fax:
Practice Address - Street 1:16585 NW 2ND AVE
Practice Address - Street 2:#300
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-6038
Practice Address - Country:US
Practice Address - Phone:305-947-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4115111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88935Medicare ID - Type Unspecified