MEDICARE: DR. NATHANIEL ROBERT HISS DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	08002335A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000539789	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1841484482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHANIEL ROBERT HISS DC

Provider Business Mailing Address
First Line	:	6215 COVINGTON RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-7311
Country	:	US
Telephone Number	:	260-755-5953
Fax Number	:	260-755-5956

Provider Business Practice Location Address
First Line	:	6215 COVINGTON RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-7311
Country	:	US
Telephone Number	:	260-755-5953
Fax Number	:	260-755-5956

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	07/15/2013

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