Provider Demographics
NPI:1245394790
Name:BLISS, CONSTANCE L (DC)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:L
Last Name:BLISS
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 1:901 BENNER PIKE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-7317
Mailing Address - Country:US
Mailing Address - Phone:814-237-2225
Mailing Address - Fax:814-237-2520
Practice Address - Street 1:901 BENNER PIKE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7317
Practice Address - Country:US
Practice Address - Phone:814-237-2225
Practice Address - Fax:814-237-2520
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002655L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009328720001Medicaid
PA01360451OtherHIGHMARK
PA01831401OtherCAPITAL BLUE CROSS
PA0025750000OtherINDEPENDANCE BLUE CROSS
PAT27351Medicare UPIN
PA0009328720001Medicaid