Active NPI
Derek Libby, D.C.
- Chiropractor
- Poway, CA
National Provider Identifier
1508233735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 33269
- Practice address
- 12237 Poway Rd
Poway, CA 92064-4217 - Phone
- (858) 486-3400
- NPI assigned
- Aug 24, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 33269 | CA | Primary |
Addresses
Primary practice location
12237 Poway Rd
Poway, CA 92064-4217
Mailing address
12237 Poway Rd
Poway, CA 92064-4217
Phone (858) 486-3400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160713001771 | CA | Practitioner - Chiropractic | 9638461502 | Practice locations: Poway, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Other, 2014
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
12237 Poway Rd
Poway, CA 92064-4217
Phone (858) 486-3400
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33269 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457913600000",
"number": "1508233735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12237 POWAY RD",
"city": "POWAY",
"state": "CA",
"postal_code": "920644217",
"telephone_number": "858-486-3400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12237 POWAY RD",
"city": "POWAY",
"state": "CA",
"postal_code": "920644217",
"telephone_number": "858-486-3400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIBBY",
"first_name": "DEREK",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-08-24",
"last_updated": "2016-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "33269",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Poway, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2016; 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.