Provider Demographics
NPI:1679200109
Name:ACEVEDO, MARISSA IRENE (DC)
Entity type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:IRENE
Last Name:ACEVEDO
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:IRENE
Other - Last Name:LEIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1523
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-1523
Mailing Address - Country:US
Mailing Address - Phone:479-571-6038
Mailing Address - Fax:479-571-0222
Practice Address - Street 1:1105 SHIPLEY ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5453
Practice Address - Country:US
Practice Address - Phone:479-715-3265
Practice Address - Fax:479-365-7444
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16357111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor