Individual provider Active NPI

Bryce Jonathan Staker, D.C.

  • Chiropractor
  • Geneva, IL
National Provider Identifier
1013926534
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Practice address
501 Lark St
Geneva, IL 60134-2526
Phone
(630) 232-6616
Fax
(630) 232-6681
NPI assigned
Aug 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X IL Primary

Addresses

Primary practice location

501 Lark St
Geneva, IL 60134-2526

Mailing address

501 Lark St
P. O. Box 47
Geneva, IL 60134-2526
Phone (630) 232-6616

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060905000065 IL Practitioner - Chiropractic 2567466691 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. Charles Service CorporationGroup PAC ID 1456501667, 5 clinicians
Sycamore Service CorporationGroup PAC ID 2769448646, 3 clinicians
Staker Chiropractic Life Center P CGroup PAC ID 5496759524, 2 clinicians

Practice addresses (Care Compare)

1615 W Main St
St Charles, IL 60174-1629
Phone (630) 513-0600

1680 Mediterranean Dr
Suite 101
Sycamore, IL 60178-3193
Phone (815) 899-6061

501 Lark St
Geneva, IL 60134-2526
Phone (630) 232-6616

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038-010753ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Staker Chiropractic Life Center P C Chiropractor CurrentSince Aug 5, 2006 Accepting new patients
Sycamore Service Corporation Chiropractor CurrentSince May 13, 2024 Accepting new patients
St. Charles Service Corporation Chiropractor CurrentSince Apr 9, 2024 Accepting new patients
Elmhurst Olympic Service Corporation Chiropractor PastSince Sep 6, 2006 Accepting new patients
Carol Stream Service Corporation Chiropractor Past Accepting new patients

Locations

260 E Army Trail Rd
Ste D
Bartlett, IL 60103
Phone (630) 830-8600

501 Lark St
Geneva, IL 60134
Phone (630) 232-6616

1615 W Main St
St Charles, IL 60174
Phone (630) 513-0600

1680 Mediterranean Dr
Ste 101
Sycamore, IL 60178
Phone (815) 899-6061

Networks

  • devoted network organization-1baeae7e-6b6f-49f9-a562-1b2d2e55c806

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013926534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 LARK ST",
            "address_2": "P. O. BOX 47",
            "city": "GENEVA",
            "state": "IL",
            "postal_code": "601342526",
            "telephone_number": "630-232-6616",
            "fax_number": "630-232-6681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 LARK ST",
            "city": "GENEVA",
            "state": "IL",
            "postal_code": "601342526",
            "telephone_number": "630-232-6616",
            "fax_number": "630-232-6681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAKER",
        "first_name": "BRYCE",
        "middle_name": "JONATHAN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Geneva, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.