Provider Demographics
NPI:1194024471
Name:MARSHALL, MELISSA GRACE (DC)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:GRACE
Last Name:MARSHALL
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 1:229 N BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-1630
Mailing Address - Country:US
Mailing Address - Phone:517-627-7070
Mailing Address - Fax:517-627-0976
Practice Address - Street 1:229 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-1630
Practice Address - Country:US
Practice Address - Phone:517-627-7070
Practice Address - Fax:517-627-0976
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009777111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor