{
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"FirstLineMailingAddress": "1804 BENTBROOK DR",
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"MailingAddressStateName": "IL",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "217-352-2711",
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"FirstLinePracticeLocationAddress": "3002 CROSSING CT",
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"EnumerationDate": "08/27/2009",
"LastUpdateDate": "10/25/2016",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SEIBERT",
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"AuthorizedOfficialCredential": "D.M.D., MS",
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{
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},
{
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}
]
},
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}
}