{
"Npi": {
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CHIROSPORT AND SPINE, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3103 CHATHAM RD.",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ENDWELL",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "13760",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "607-321-7674",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "421 E. MAIN ST.",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ENDICOTT",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "13760",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "607-321-7674",
"PracticeLocationAddressFaxNumber": "855-890-7728",
"EnumerationDate": "01/29/2014",
"LastUpdateDate": "04/29/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BALDIA",
"AuthorizedOfficialFirstName": "BRIAN",
"AuthorizedOfficialMiddleName": "L.",
"AuthorizedOfficialTitle": "OWNER/CHIROPRACTOR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "267-253-7808",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "DC007952L",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "X012250-1",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
]
}
}
}