Lakeside Chiropractic PC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

LAKESIDE CHIROPRACTIC PC

Practice address

10633 State Highway 18
Conneaut Lake, PA 16316-3225

Phone

(814) 382-1970

Fax

(814) 382-3619

NPI assigned

Aug 4, 2006

Last updated

May 3, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Timothy B Vyrostek, DC CCSPNPI 1003929308

Title

Clinic Director

Phone

(814) 382-1970

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Timothy B Vyrostek, DC CCSP

  • Sports Physician Chiropractor
  • Conneaut Lake, PA
  • NPI 1003929308
  Medicare reassignment NPD Authorized official
• Casey James Chapman, DC

  • Chiropractor
  • Conneaut Lake, PA
  • NPI 1477468007
  NPD (past)

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683072000000",
    "number": "1992713903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10633 STATE HIGHWAY 18",
            "city": "CONNEAUT LAKE",
            "state": "PA",
            "postal_code": "163163225",
            "telephone_number": "814-382-1970",
            "fax_number": "814-382-3619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10633 STATE HIGHWAY 18",
            "city": "CONNEAUT LAKE",
            "state": "PA",
            "postal_code": "163163225",
            "telephone_number": "814-382-1970",
            "fax_number": "814-382-3619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE CHIROPRACTIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2023-05-03",
        "certification_date": "2023-05-03",
        "status": "A",
        "authorized_official_last_name": "VYROSTEK",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "814-382-1970",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC CCSP"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA",
            "identifier": "350056097",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "350056097",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karima Mental Health Services LLC (Nour Alabase)
• Beverly A Kennedy, RPH
• Brett Alan Keyser, D.C.
• Carolyn Knox
• Casey Lynn Kusich, RD, LDN
• Lakeside Physical Therapy and Wellness LLC
• Izabella Leguard, MPAS, PA-C
• Mark J Leonard, P.T., D.P.T.
• Kimberly Nicole Litwin, PHARMD
• Candyce A. Lucian, D.O.

• Chiropractor in Conneaut Lake, PA
• Providers in Conneaut Lake, PA by specialty
• Chiropractor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.