Provider Demographics
NPI:1609804012
Name:CRISMAN, ROBERT LLOYD JR (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LLOYD
Last Name:CRISMAN
Suffix:JR
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 1:220 N MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650
Mailing Address - Country:US
Mailing Address - Phone:864-848-0708
Mailing Address - Fax:864-848-9918
Practice Address - Street 1:220 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650
Practice Address - Country:US
Practice Address - Phone:864-848-0708
Practice Address - Fax:864-848-9918
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1781111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH17Medicaid
SC4552Medicare PIN
SCCH17Medicaid