Healthcare Provider Details

I. General information

NPI: 1437192093
Provider Name (Legal Business Name): JASON P LASKE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24640 TELEGRAPH RD
FLAT ROCK MI
48134-9226
US

IV. Provider business mailing address

24640 TELEGRAPH RD
FLAT ROCK MI
48134-9226
US

V. Phone/Fax

Practice location:
  • Phone: 734-782-0200
  • Fax: 734-789-7876
Mailing address:
  • Phone: 734-782-0200
  • Fax: 734-789-7876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301008988
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: