Individual provider Active NPI

Lance Avery Myers, D.C.

  • Chiropractor
  • Rockford, IL
National Provider Identifier
1093040578
Registry record updated Dec 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038011531 Issued in IL
Practice address
6030 Garrett LN
Rockford, IL 61107-6637
Phone
(815) 398-4004
Fax
(815) 398-4005
NPI assigned
Oct 16, 2009
Last updated
Dec 26, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038011531 IL Primary

Addresses

Primary practice location

6030 Garrett LN
Rockford, IL 61107-6637

Mailing address

6030 Garrett LN
Rockford, IL 61107-6637
Phone (815) 398-4004

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100212000337 IL Practitioner - Chiropractic 7012051139 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
National College of Chiropractic, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Caraotta Chiropractic PCGroup PAC ID 5597853903, 4 clinicians

Practice addresses (Care Compare)

6030 Garrett LN
Rockford, IL 61107-6637

6030 Garrett LN
Suite 1
Rockford, IL 61107-6638
Phone (815) 398-4004

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1255651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735171200000",
    "number": "1093040578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6030 GARRETT LN",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611076637",
            "telephone_number": "815-398-4004",
            "fax_number": "815-398-4005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6030 GARRETT LN",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611076637",
            "telephone_number": "815-398-4004",
            "fax_number": "815-398-4005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYERS",
        "first_name": "LANCE",
        "middle_name": "AVERY",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-10-16",
        "last_updated": "2024-12-26",
        "certification_date": "2024-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038011531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2024; 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.