Provider Demographics
NPI:1649483157
Name:BOUSKA, RACHEL R (DC)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:R
Last Name:BOUSKA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2837 DARLING COURT
Mailing Address - Street 2:
Mailing Address - City:LACROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4478
Mailing Address - Country:US
Mailing Address - Phone:608-783-3040
Mailing Address - Fax:844-248-2389
Practice Address - Street 1:2837 DARLING COURT
Practice Address - Street 2:
Practice Address - City:LACROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4478
Practice Address - Country:US
Practice Address - Phone:608-783-3040
Practice Address - Fax:844-248-2389
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4959111N00000X
WI4420-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38181100Medicaid
WI000535370Medicare PIN