{
"Npi": {
"NPI": "1033565510",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MINNESOTA DISC REPLACEMENT AND SPINE RESTORATION CENTER",
"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": "6 RED FOREST LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NORTH OAKS",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55127-6352",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "612-888-1433",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4444 76 ST",
"SecondLinePracticeLocationAddress": "#700",
"PracticeLocationAddressCityName": "EDINA",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55435",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "612-888-1433",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/13/2016",
"LastUpdateDate": "05/13/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MILLER",
"AuthorizedOfficialFirstName": "LYNN",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.O.",
"AuthorizedOfficialTelephoneNumber": "612-888-1433",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM2500X",
"TaxonomyName": "Medical Specialty Clinic/Center",
"LicenseNumber": "50690",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}