Provider Demographics
NPI:1518680024
Name:YANCOSEK, JESSE ARON (DC)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:ARON
Last Name:YANCOSEK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JESSE
Other - Middle Name:ARON
Other - Last Name:YANCOSEK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:551 FIELDVIEW PL
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3510
Mailing Address - Country:US
Mailing Address - Phone:805-345-7560
Mailing Address - Fax:
Practice Address - Street 1:30332 ESPERANZA
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2118
Practice Address - Country:US
Practice Address - Phone:949-264-6440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36327111N00000X
IDCHIA-2296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor