{
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"EIN": null,
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"IsOrgSubpart": "N",
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"LastName": null,
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"FirstLineMailingAddress": "5850 OBERLIN DR STE 220",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN DIEGO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92121-4711",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "858-453-0366",
"MailingAddressFaxNumber": "858-453-0370",
"FirstLinePracticeLocationAddress": "5850 OBERLIN DR STE 220",
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"PracticeLocationAddressCityName": "SAN DIEGO",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "858-453-0366",
"PracticeLocationAddressFaxNumber": "858-453-0370",
"EnumerationDate": "07/25/2018",
"LastUpdateDate": "07/25/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VISICO",
"AuthorizedOfficialFirstName": "CHRISTOPHER",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "858-453-0366",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "34262",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X 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."
}
}
}
}