{
"Npi": {
"NPI": "1043833015",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BEND CENTER FOR INTEGRATIVE HEALTH AND WELLNESS LLC",
"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": "2660 NE HIGHWAY 20 STE 610-447",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BEND",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97701-6402",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "568 NE SAVANNAH DR STE 5",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BEND",
"PracticeLocationAddressStateName": "OR",
"PracticeLocationAddressPostalCode": "97701-4866",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "541-668-1881",
"PracticeLocationAddressFaxNumber": "888-658-6924",
"EnumerationDate": "05/25/2020",
"LastUpdateDate": "05/25/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TABBADA",
"AuthorizedOfficialFirstName": "CHRISTABEL",
"AuthorizedOfficialMiddleName": "G",
"AuthorizedOfficialTitle": "CO-OWNER",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "L.AC.",
"AuthorizedOfficialTelephoneNumber": "541-668-1881",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "225700000X",
"TaxonomyName": "Massage Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "171100000X",
"TaxonomyName": "Acupuncturist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
},
{
"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."
}
]
}
}
}