Provider Demographics
NPI:1629047519
Name:SLUSARSKI, ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:SLUSARSKI
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 1:23 N ORCHARD FARMS AVE
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-4866
Mailing Address - Country:US
Mailing Address - Phone:864-288-3163
Mailing Address - Fax:
Practice Address - Street 1:700G GARLINGTON RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5435
Practice Address - Country:US
Practice Address - Phone:864-281-1456
Practice Address - Fax:864-281-0526
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2888111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC200723704OtherFEDERAL TAX ID
SCU98926Medicare UPIN
SC200723704OtherFEDERAL TAX ID