MEDICARE: MARISSA NICOLE BASS 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	31978	CA

General Provider Information

NPI Number	:	1558629808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA NICOLE BASS D.C.

Provider Business Mailing Address
First Line	:	371 N LA CIENEGA BLVD
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90048-1924
Country	:	US
Telephone Number	:	323-944-0773
Fax Number	:

Provider Business Practice Location Address
First Line	:	371 N LA CIENEGA BLVD
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90048-1924
Country	:	US
Telephone Number	:	323-944-0773
Fax Number	:

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

Provider Enumeration Date	:	04/24/2012
Last Update Date	:	07/21/2022

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