Provider Demographics
NPI:1558405381
Name:BLISS, BONNIE D (DC)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:D
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:PO BOX 1619
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99156
Mailing Address - Country:US
Mailing Address - Phone:509-447-2413
Mailing Address - Fax:509-447-2413
Practice Address - Street 1:601 STATE ROUTE 20
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:WA
Practice Address - Zip Code:99156
Practice Address - Country:US
Practice Address - Phone:509-447-2413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00000964111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T02251Medicare UPIN
WA000300117Medicare PIN