MEDICARE: MARISSA LEIGH WOSSNER DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH13020	FL

General Provider Information

NPI Number	:	1528608452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA LEIGH WOSSNER DC

Provider Business Mailing Address
First Line	:	5008 MILLENIA PALMS DR APT 1104
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-2229
Country	:	US
Telephone Number	:	815-409-5291
Fax Number	:

Provider Business Practice Location Address
First Line	:	2112 WINDING RIVER DR STE 120
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-8555
Country	:	US
Telephone Number	:	630-428-2299
Fax Number	:	224-330-1920

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2020
Last Update Date	:	01/18/2021

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