Provider Demographics
NPI:1790906485
Name:JESKE, KARL H (DC)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:H
Last Name:JESKE
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 1:5252 BROADVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-1630
Mailing Address - Country:US
Mailing Address - Phone:440-882-3200
Mailing Address - Fax:440-882-3201
Practice Address - Street 1:5252 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-1630
Practice Address - Country:US
Practice Address - Phone:440-882-3200
Practice Address - Fax:440-882-3201
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2972111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH220835OtherANTHEM BCBS
OH115575OtherHEALTH PARTNERS
OH610330100OtherDEPT OF LABOR
OH2226175Medicaid
OH350050100OtherRAILROAD MEDICARE
OH2226175Medicaid
OH610330100OtherDEPT OF LABOR