{
"Npi": {
"NPI": "1023372067",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "RIVERSIDE CHIROPRACTIC WELLNESS CENTERS, INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "181 TAFT RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WILMINGTON",
"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "01887-2820",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "781-395-0003",
"MailingAddressFaxNumber": "781-395-2223",
"FirstLinePracticeLocationAddress": "65 RIVERSIDE AVE STE C",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MEDFORD",
"PracticeLocationAddressStateName": "MA",
"PracticeLocationAddressPostalCode": "02155-4653",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "781-395-0003",
"PracticeLocationAddressFaxNumber": "781-395-2223",
"EnumerationDate": "06/25/2012",
"LastUpdateDate": "06/25/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "POURSHADI",
"AuthorizedOfficialFirstName": "REZA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "781-395-0003",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "2413",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}