Provider Demographics
NPI:1619960739
Name:JESKO, CHARLES M (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:M
Last Name:JESKO
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 1:2620 MEMORIAL BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-1488
Mailing Address - Country:US
Mailing Address - Phone:724-322-7542
Mailing Address - Fax:
Practice Address - Street 1:2620 MEMORIAL BLVD STE E
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-1488
Practice Address - Country:US
Practice Address - Phone:724-322-7542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007960L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
053807PQUMedicare ID - Type Unspecified
U88349Medicare UPIN