Provider Demographics
NPI:1710060801
Name:BLISS, ROBERT FOSTER (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FOSTER
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 1:25 MITCHELL BLVD # 2
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903
Mailing Address - Country:US
Mailing Address - Phone:415-472-1610
Mailing Address - Fax:415-472-0143
Practice Address - Street 1:25 MITCHELL BLVD # 2
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903
Practice Address - Country:US
Practice Address - Phone:415-472-1610
Practice Address - Fax:415-472-0143
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10131OtherSTATE OF CALIF
CA10131OtherSTATE OF CALIF