Individual provider Active NPI

Leilani Bettencourt, D.C.

  • Chiropractor
  • San Jose, CA
National Provider Identifier
1255496162
Registry record updated Jan 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DC29239 Issued in CA
Practice address
1620 Westwood Dr
Suite D
San Jose, CA 95125-5114
Phone
(408) 448-0505
Fax
(408) 448-0504
NPI assigned
Dec 22, 2006
Last updated
Jan 30, 2008By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 30, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X DC29239 CA Primary

Addresses

Primary practice location

1620 Westwood Dr
Suite D
San Jose, CA 95125-5114

Mailing address

1620 Westwood Dr
Suite D
San Jose, CA 95125-5114
Phone (408) 448-0505

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041015000437 CA Practitioner - Chiropractic 3375503154 Practice locations: San Jose, CA

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - West Sunnyvale, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1620 Westwood Dr
Suite D
San Jose, CA 95125-5114
Phone (408) 448-0505

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DC29239CAMDChiropractor
29239CAMDGeriatric Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Chiropractic Office of Dr. Jessica Paige Corporation PastSince Dec 3, 2023 Accepting new patients

Organizations & group practices 1

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": "1166745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201651200000",
    "number": "1255496162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 WESTWOOD DR",
            "address_2": "SUITE D",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951255114",
            "telephone_number": "408-448-0505",
            "fax_number": "408-448-0504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 WESTWOOD DR",
            "address_2": "SUITE D",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951255114",
            "telephone_number": "408-448-0505",
            "fax_number": "408-448-0504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BETTENCOURT",
        "first_name": "LEILANI",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-22",
        "last_updated": "2008-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC29239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2008; 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.