{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "DR TRACY RAE SIMON CHIROPRACTIC INC",
"LastName": null,
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"FirstLineMailingAddress": "530 W MONTE VISTA AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "VACAVILLE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95688-3620",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "707-448-9661",
"MailingAddressFaxNumber": "707-448-9663",
"FirstLinePracticeLocationAddress": "530 W MONTE VISTA AVE",
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"PracticeLocationAddressCityName": "VACAVILLE",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "707-448-9661",
"PracticeLocationAddressFaxNumber": "707-448-9663",
"EnumerationDate": "03/08/2007",
"LastUpdateDate": "06/24/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SKINNER SIMON",
"AuthorizedOfficialFirstName": "TRACY",
"AuthorizedOfficialMiddleName": "RAE",
"AuthorizedOfficialTitle": "OWNER PRESIDENT",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "707-448-9661",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "DC27700",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}