Provider Demographics
NPI:1003134255
Name:LISS, DONALD L (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:L
Last Name:LISS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1799 BRENTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4611
Mailing Address - Country:US
Mailing Address - Phone:631-434-6685
Mailing Address - Fax:631-434-8575
Practice Address - Street 1:1799 BRENTWOOD RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4611
Practice Address - Country:US
Practice Address - Phone:631-434-6685
Practice Address - Fax:631-434-8575
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008364-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor