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General NPI Number Information
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NPI Number | 1578860482
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Entity Type | Individual
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Provider Name | IAN DREW FLISS DC
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Gender | Male
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Dates
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Enumeration Date | 02/13/2011
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Last Update Date | 11/18/2016
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Provider Practice Location Address
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Address Line | 560 ALLEN RD
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City | BASKING RIDGE
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State | NJ
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Zip | 07920-3848
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Country | US
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Telephone | 908-234-9400
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Fax | 908-234-9477
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Provider Business Mailing Address
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Address Line | 3 DEER HILL DR
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City | MONTVILLE
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State | NJ
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Zip | 07045-9678
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Country | US
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Telephone | 908-234-9400
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Fax | 908-234-9477
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 38MC00688200
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License Number State | NJ
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