Provider Demographics
NPI:1972674620
Name:LASKOW, JAMES ALLEN (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALLEN
Last Name:LASKOW
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 1:822 LAKE ST S
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-2614
Mailing Address - Country:US
Mailing Address - Phone:651-464-3030
Mailing Address - Fax:651-982-6034
Practice Address - Street 1:822 LAKE ST S
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2614
Practice Address - Country:US
Practice Address - Phone:651-464-3030
Practice Address - Fax:651-982-6034
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3552111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN144T1NOOtherBLUE CROSS BLUE SHIELD
MN144T1NOOtherBLUE CROSS BLUE SHIELD