Provider Demographics
NPI:1164587960
Name:PASCAL, ROBERT LEWIS (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEWIS
Last Name:PASCAL
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 1:1182 WATERFRONT DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7427
Mailing Address - Country:US
Mailing Address - Phone:843-364-9879
Mailing Address - Fax:843-722-4845
Practice Address - Street 1:202 CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3785
Practice Address - Country:US
Practice Address - Phone:843-899-9088
Practice Address - Fax:843-899-9088
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1805111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1805Medicaid
SCT377354634Medicare ID - Type Unspecified
SCT37735Medicare UPIN