Provider Demographics
NPI:1245533025
Name:FETHERMAN, MARISSA ELIZABETH (DC)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:ELIZABETH
Last Name:FETHERMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:ELIZABETH
Other - Last Name:LEPPEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:6152 N US HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-1806
Mailing Address - Country:US
Mailing Address - Phone:586-255-0393
Mailing Address - Fax:
Practice Address - Street 1:6152 N US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-1806
Practice Address - Country:US
Practice Address - Phone:586-255-0393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2015-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11265111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor