Provider Demographics
NPI:1508613217
Name:ROESKE, MARISSA (DC)
Entity type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:
Last Name:ROESKE
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8320 EASY ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ANN
Mailing Address - State:MI
Mailing Address - Zip Code:49650-9413
Mailing Address - Country:US
Mailing Address - Phone:231-342-3773
Mailing Address - Fax:
Practice Address - Street 1:1030 HASTINGS ST STE 110
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3470
Practice Address - Country:US
Practice Address - Phone:231-342-3773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301401498111N00000X
MN7242111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor