Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC-4903-L | PA |
NPI | 1508825118 |
---|---|
Provider Name | Dr. Stuart Evan Lakernick |
First Address | Holland, PA 18966-1733 |
Second Address | Holland, PA 18966-1733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 24/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
LA1555713 | CHIROPRACTOR (01) | PA |
LA700896 | CHIROPRACTOR (01) | PA |
U31942 | (02) | PA |