{
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WELBORN DC PROFESSIONAL CORPORATION",
"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": "1269 PLEASANT GROVE BLVD",
"SecondLineMailingAddress": "SUITE 190",
"MailingAddressCityName": "ROSEVILLE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95747-5885",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "530-401-6512",
"MailingAddressFaxNumber": "877-372-6670",
"FirstLinePracticeLocationAddress": "1269 PLEASANT GROVE BLVD",
"SecondLinePracticeLocationAddress": "SUITE 190",
"PracticeLocationAddressCityName": "ROSEVILLE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95747-5885",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "530-401-6512",
"PracticeLocationAddressFaxNumber": "877-372-6670",
"EnumerationDate": "10/06/2009",
"LastUpdateDate": "03/13/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WELBORN",
"AuthorizedOfficialFirstName": "KATHARINA",
"AuthorizedOfficialMiddleName": "CHRISTINE",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "530-401-6512",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "B01061",
"LicenseNumberStateCode": "NV",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "DC 29-303",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
]
}
}
}