MEDICARE: MELISSA A VANDERMISSEN D.C.

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	4973-12	WI
2	111N00000X	Chiropractor	2301009510	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639307473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA A VANDERMISSEN D.C.

Provider Business Mailing Address
First Line	:	N3860 BASS LAKE RD
Second Line	:
City	:	IRON MOUNTAIN
State	:	MI
Zip	:	49801-9306
Country	:	US
Telephone Number	:	920-770-3250
Fax Number	:

Provider Business Practice Location Address
First Line	:	N3860 BASS LAKE RD
Second Line	:
City	:	IRON MOUNTAIN
State	:	MI
Zip	:	49801-9306
Country	:	US
Telephone Number	:	920-770-3250
Fax Number	:

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

Provider Enumeration Date	:	07/01/2009
Last Update Date	:	10/02/2019

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