Provider Demographics
NPI:1831924505
Name:UY, MARISSA (DC)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:UY
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 1:1813 EL CAMINO REAL STE 19
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3229
Mailing Address - Country:US
Mailing Address - Phone:650-200-3505
Mailing Address - Fax:
Practice Address - Street 1:1813 EL CAMINO REAL STE 19
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3229
Practice Address - Country:US
Practice Address - Phone:650-200-3505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-36962111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor