Provider Demographics
NPI:1164415253
Name:BLISS, NORMAN EUGENE (DC)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:EUGENE
Last Name:BLISS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N US HIGHWAY 65
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:MO
Mailing Address - Zip Code:64633-1975
Mailing Address - Country:US
Mailing Address - Phone:660-542-2441
Mailing Address - Fax:
Practice Address - Street 1:1300 N US HIGHWAY 65
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:MO
Practice Address - Zip Code:64633-1975
Practice Address - Country:US
Practice Address - Phone:660-542-2441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE4137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO09741021OtherBCBS KC
MO0004996Medicare ID - Type Unspecified
MO09741021OtherBCBS KC