Provider Demographics
NPI:1578860482
Name:FLISS, IAN DREW (DC)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:DREW
Last Name:FLISS
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 1:3 DEER HILL DR
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9678
Mailing Address - Country:US
Mailing Address - Phone:908-234-9400
Mailing Address - Fax:908-234-9477
Practice Address - Street 1:560 ALLEN RD
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-3848
Practice Address - Country:US
Practice Address - Phone:908-234-9400
Practice Address - Fax:908-234-9477
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-13
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00688200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor