Individual provider Active NPI

Marc Richard Gottlieb, D.C.

  • Chiropractor
  • San Diego, CA
National Provider Identifier
1023258605
Registry record updated Feb 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DC26726 Issued in CA
Practice address
1452 University Ave
San Diego, CA 92103-3405
Phone
(619) 291-5433
Fax
(619) 209-3608
NPI assigned
Feb 23, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X DC26726 CA Primary

Addresses

Primary practice location

1452 University Ave
San Diego, CA 92103-3405

Mailing address

1452 University Ave
San Diego, CA 92103-3405
Phone (619) 291-5433

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100712000488 CA Practitioner - Chiropractic 2062544943 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - West Sunnyvale, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1452 University Ave
San Diego, CA 92103-3405
Phone (619) 291-5433

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DC26726CAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Gottlieb Chiropractic Inc Chiropractor CurrentSince Apr 18, 2010 Accepting new patients
H G Heeder Chiropractic Inc PastSince Apr 18, 2010 Accepting new patients

Locations

1452 University Ave
San Diego, CA 92103
Phone (619) 291-5433

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1235347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235347200000",
    "number": "1023258605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1452 UNIVERSITY AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921033405",
            "telephone_number": "619-291-5433",
            "fax_number": "619-209-3608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1452 UNIVERSITY AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921033405",
            "telephone_number": "619-291-5433",
            "fax_number": "619-209-3608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOTTLIEB",
        "first_name": "MARC",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-23",
        "last_updated": "2009-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC26726",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2009; 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.