Provider Demographics
NPI:1043335102
Name:BOUSQUET, ROBERT G (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:BOUSQUET
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 1:655 FAIRVIEW RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-7500
Mailing Address - Country:US
Mailing Address - Phone:864-962-8800
Mailing Address - Fax:864-228-9129
Practice Address - Street 1:655 FAIRVIEW RD
Practice Address - Street 2:SUITE J
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-7500
Practice Address - Country:US
Practice Address - Phone:864-962-8800
Practice Address - Fax:864-228-9129
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCH2296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2296Medicaid
SCCH2296Medicaid