Provider Demographics
NPI:1528608452
Name:WOSSNER, MARISSA LEIGH (DC)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:LEIGH
Last Name:WOSSNER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5008 MILLENIA PALMS DR APT 1104
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-2229
Mailing Address - Country:US
Mailing Address - Phone:815-409-5291
Mailing Address - Fax:
Practice Address - Street 1:2112 WINDING RIVER DR STE 120
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8555
Practice Address - Country:US
Practice Address - Phone:630-428-2299
Practice Address - Fax:224-330-1920
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13020111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor