Provider Demographics
NPI:1437192093
Name:LASKE, JASON P (DC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:P
Last Name:LASKE
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 1:24640 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:MI
Mailing Address - Zip Code:48134-9226
Mailing Address - Country:US
Mailing Address - Phone:734-782-0200
Mailing Address - Fax:734-789-7876
Practice Address - Street 1:24640 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:MI
Practice Address - Zip Code:48134-9226
Practice Address - Country:US
Practice Address - Phone:734-782-0200
Practice Address - Fax:734-789-7876
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1337001OtherINDIVIDUAL MEDICARE PTAN
MI900072659OtherPRIORITY HEALTH
MIP00690884OtherUNITED HEALTH CARE
MIV10353OtherHAP
MI1437192093OtherINDIVIDUAL NPI
MI1679710800OtherGROUP NPI
MI1013467323OtherGROUP NPI
MI4948941OtherMEDICAID
MI950H242880OtherBLUE CROSS
MIMI1337OtherGROUP MEDICARE PTAN