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General NPI Number Information
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NPI Number | 1336938471
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Entity Type | Organization
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Legal Business Name | CHIROPRACTHER, PLLC
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Dates
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Enumeration Date | 05/05/2025
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 1030 HASTINGS ST STE 110
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City | TRAVERSE CITY
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State | MI
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Zip | 49686-3470
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Country | US
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Telephone | 231-342-3773
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Fax |
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Provider Business Mailing Address
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Address Line | 8320 EASY ST
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City | LAKE ANN
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State | MI
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Zip | 49650-9413
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Country | US
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Telephone | 231-342-3773
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | MARISSA ROESKE
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Credential | DC
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Telephone | 231-342-3773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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