Provider Demographics
NPI:1184634271
Name:SKOUSON, ROBERT HAROLD (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HAROLD
Last Name:SKOUSON
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 1:911 BALDWIN RD
Mailing Address - Street 2:STE A
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446
Mailing Address - Country:US
Mailing Address - Phone:810-664-1111
Mailing Address - Fax:810-664-7199
Practice Address - Street 1:911 BALDWIN RD
Practice Address - Street 2:STE A
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446
Practice Address - Country:US
Practice Address - Phone:810-664-1111
Practice Address - Fax:810-664-7199
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008066111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4262675Medicaid
U82686Medicare UPIN
0N20980Medicare ID - Type Unspecified