Provider Demographics
NPI:1679710800
Name:LASKE FAMILY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:LASKE FAMILY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:P
Authorized Official - Last Name:LASKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-283-2180
Mailing Address - Street 1:20720 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-5313
Mailing Address - Country:US
Mailing Address - Phone:734-283-2180
Mailing Address - Fax:734-283-2188
Practice Address - Street 1:20720 EUREKA RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-5313
Practice Address - Country:US
Practice Address - Phone:734-283-2180
Practice Address - Fax:734-283-2188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2301008988OtherLICENSE#
MI950H242200OtherBLUE CROSS IND
950H242880OtherBLUE CROSS GROUP
MI1437192093OtherIND. NPI#
MI144948941Medicaid
MI900072659OtherPRIORITY HEALTH
MIP00690884OtherUNITED HEALTHCARE
MIV10353OtherHAP
MI900072659OtherPRIORITY HEALTH
MIMI1337Medicare PIN