Organization Active NPI

Life Chiropractic College West

  • Chiropractor
  • Hayward, CA
National Provider Identifier
1376615807
Registry record updated Apr 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
LIFE CHIROPRACTIC COLLEGE WEST
Practice address
25001 Industrial Blvd
Hayward, CA 94545-2801
Phone
(510) 780-4567
Fax
(510) 780-4567
NPI assigned
Nov 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2014

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

Authorized official

Name
Dr. Timothy John Gay, D.C.
Title
Health CNTR Director
Phone
(510) 780-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X CA Primary

Addresses

Primary practice location

25001 Industrial Blvd
Hayward, CA 94545-2801

Mailing address

25001 Industrial Blvd
Hayward, CA 94545-2801
Phone (510) 780-4567

Other names 1

  • LIFE CHIROPRACTIC COLLEGE WEST Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, NE2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050429000555 CA Part B Supplier - Clinic/Group Practice 9234178138 Receives reassigned benefits from 8 practitioners
Practice locations: Hayward, CA
O20240603000708 NE Part B Supplier - Clinic/Group Practice 9234178138 Practice locations: Bellevue, NE

National Provider Directory

National Provider Directory

Locations

818 Bruin Blvd
Bellevue, NE 68005
Phone (531) 600-5900

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397174400000",
    "number": "1376615807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25001 INDUSTRIAL BLVD",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "945452801",
            "telephone_number": "510-780-4567",
            "fax_number": "510-780-4513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25001 INDUSTRIAL BLVD",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "945452801",
            "telephone_number": "510-780-4567",
            "fax_number": "510-780-4567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE CHIROPRACTIC COLLEGE WEST",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2014-04-11",
        "status": "A",
        "authorized_official_last_name": "GAY",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "HEALTH CNTR DIRECTOR",
        "authorized_official_telephone_number": "510-780-4000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LIFE CHIROPRACTIC COLLEGE WEST",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Hayward, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2014; 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.