Individual provider Active NPI

Stuart Evan Lakernick, D.C.

  • Neurology Chiropractor
  • Trevose, PA
National Provider Identifier
1508825118
Registry record updated May 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology ChiropractorTaxonomy code 111NN0400X
License
DC-4903-L Issued in PA
Practice address
639 E Myrtle Ave
Trevose, PA 19053-4640
Phone
(215) 355-8336
Fax
(215) 355-7550
NPI assigned
Mar 22, 2006
Last updated
May 12, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 12, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Chiropractor 111NN0400X DC-4903-L PA Primary

Addresses

Primary practice location

639 E Myrtle Ave
Trevose, PA 19053-4640

Mailing address

639 E Myrtle Ave
Trevose, PA 19053-4640
Phone (215) 355-8336

Other identifiers 2

IdentifierTypeStateIssuer
LA700896OtherPACHIROPRACTOR
LA1555713OtherPACHIROPRACTOR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110318000457 PA Practitioner - Chiropractic 7315120995 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

639 E Myrtle Ave
Trevose, PA 19053-4640
Phone (215) 355-8336

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DC-4903-LPAMDNeurology Chiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Lakernick Family Chiropractic Neurology CurrentSince Feb 7, 2011 Accepting new patients

Locations

295 Buck Rd
Ste 305
Southampton, PA 18966
Phone (215) 355-8336

639 E Myrtle Ave
Trevose, PA 19053
Phone (215) 355-8336

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": "1142985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652313600000",
    "number": "1508825118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "639 E MYRTLE AVE",
            "city": "TREVOSE",
            "state": "PA",
            "postal_code": "190534640",
            "telephone_number": "215-355-8336",
            "fax_number": "215-355-7550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "639 E MYRTLE AVE",
            "city": "TREVOSE",
            "state": "PA",
            "postal_code": "190534640",
            "telephone_number": "215-355-8336",
            "fax_number": "215-355-7550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKERNICK",
        "first_name": "STUART",
        "middle_name": "EVAN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-22",
        "last_updated": "2022-05-12",
        "certification_date": "2022-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NN0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Neurology",
            "state": "PA",
            "license": "DC-4903-L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIROPRACTOR",
            "identifier": "LA700896",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIROPRACTOR",
            "identifier": "LA1555713",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Trevose, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2022; 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.