Provider Demographics
NPI:1396529699
Name:NEUMAN, MARISSA CHRISTINA ZAIN (LAC)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:CHRISTINA ZAIN
Last Name:NEUMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5211 CASCADE RD SE STE 103
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6495
Mailing Address - Country:US
Mailing Address - Phone:616-901-5345
Mailing Address - Fax:
Practice Address - Street 1:5211 CASCADE RD SE STE 103
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6495
Practice Address - Country:US
Practice Address - Phone:616-901-5345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5402000208171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist