Provider Demographics
NPI:1720111578
Name:JASKOWIAK CHIROPRACTIC OFFICE SC
Entity Type:Organization
Organization Name:JASKOWIAK CHIROPRACTIC OFFICE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:JASKOWIAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-255-9636
Mailing Address - Street 1:N85W15762 APPLETON AVE
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-3043
Mailing Address - Country:US
Mailing Address - Phone:262-255-9636
Mailing Address - Fax:
Practice Address - Street 1:N85W15762 APPLETON AVE
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-3043
Practice Address - Country:US
Practice Address - Phone:262-255-9636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1963111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T62312Medicare UPIN