Provider Demographics
NPI:1790007573
Name:BLISS CHRIOPRATIC PC
Entity Type:Organization
Organization Name:BLISS CHRIOPRATIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-636-8291
Mailing Address - Street 1:255 EASTERN PARKWAY
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238
Mailing Address - Country:US
Mailing Address - Phone:718-636-8291
Mailing Address - Fax:718-636-8667
Practice Address - Street 1:255 EASTERN PKWY
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-6300
Practice Address - Country:US
Practice Address - Phone:718-636-8291
Practice Address - Fax:718-636-8667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYXOO6142305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTIN