Provider Demographics
NPI:1154390375
Name:FISS, ROBERT L (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:FISS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:L
Other - Last Name:FISS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1461 LINCOLN WAY E
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17202-3341
Mailing Address - Country:US
Mailing Address - Phone:717-263-4835
Mailing Address - Fax:717-263-5117
Practice Address - Street 1:1461 LINCOLN WAY E
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17202-3341
Practice Address - Country:US
Practice Address - Phone:717-263-4835
Practice Address - Fax:717-263-5117
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002775L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADC002775OtherLICENSE
PADC002775OtherLICENSE
PAT29408Medicare UPIN