Provider Demographics
NPI:1831472778
Name:JASKULSKI, CHARLES KEITH (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:KEITH
Last Name:JASKULSKI
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 1:2190 S. TAMIAMI TRAIL
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-5040
Mailing Address - Country:US
Mailing Address - Phone:941-493-2688
Mailing Address - Fax:
Practice Address - Street 1:2190 S. TAMIAMI TRAIL
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-5040
Practice Address - Country:US
Practice Address - Phone:941-493-2688
Practice Address - Fax:941-375-5400
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10402111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor