Individual provider Active NPI

Edward T Lafferty III, DC

  • Chiropractor
  • Castle Rock, CO
National Provider Identifier
1700933926
Registry record updated Apr 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHR.0008110 Issued in CO
Practice address
103 4TH St Ste 330
Castle Rock, CO 80104-2449
Phone
(721) 645-1623
Fax
(732) 901-5044
NPI assigned
Jan 3, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 38MC00608500 NJ
Chiropractor 111N00000X CHR.0008110 CO Primary

Addresses

Primary practice location

103 4TH St Ste 330
Castle Rock, CO 80104-2449

Mailing address

103 4TH St Ste 330
Castle Rock, CO 80104-2449
Phone (721) 645-1623

Other identifiers 2

IdentifierTypeStateIssuer
CHR.0008110OtherCOCOLORADO CHIROPRACTIC LICENSE
EL.2787047OtherCOCOLORADO ELECTROTHERAPY CHIROPRACTIC LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040929000289 NJ Practitioner - Chiropractic 9830168673 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
New York Chiropractic College, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Atlantic County Family Spine RehabGroup PAC ID 0648237867, 8 clinicians

Practice addresses (Care Compare)

506 S New York Rd
Galloway, NJ 08205-9761
Phone (609) 748-0222

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CHR.0008110COMDChiropractor
38MC00608500NJMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Atlantic County Family Spine Rehab Chiropractor CurrentSince Aug 25, 2023 Accepting new patients
Pain Performance Chiropractic Health LLC Chiropractor PastSince Nov 1, 2018 Accepting new patients
Crestwood Manchester Chiropractic Chiropractor Past Accepting new patients

Locations

2500 English Creek Ave
Egg Hbr Twp, NJ 08234
Phone (609) 407-0021

Organizations & group practices 3

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": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619481600000",
    "number": "1700933926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 4TH ST STE 330",
            "city": "CASTLE ROCK",
            "state": "CO",
            "postal_code": "801042449",
            "telephone_number": "721-645-1623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 4TH ST STE 330",
            "city": "CASTLE ROCK",
            "state": "CO",
            "postal_code": "801042449",
            "telephone_number": "721-645-1623",
            "fax_number": "732-901-5044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAFFERTY",
        "first_name": "EDWARD",
        "middle_name": "T",
        "name_suffix": "III",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-03",
        "last_updated": "2021-04-27",
        "certification_date": "2021-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NJ",
            "license": "38MC00608500",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CO",
            "license": "CHR.0008110",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COLORADO CHIROPRACTIC LICENSE",
            "identifier": "CHR.0008110",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COLORADO ELECTROTHERAPY CHIROPRACTIC LICENSE",
            "identifier": "EL.2787047",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Castle Rock, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2021; 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.