{
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"OrgName": "NORTHCARE CHIROPRACTIC HEALTH CENTER, PLLC",
"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "2781 GARFIELD RD N",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TRAVERSE CITY",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "49686-5003",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "231-933-0100",
"MailingAddressFaxNumber": "231-946-1951",
"FirstLinePracticeLocationAddress": "2781 GARFIELD RD N",
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"PracticeLocationAddressCityName": "TRAVERSE CITY",
"PracticeLocationAddressStateName": "MI",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "231-933-0100",
"PracticeLocationAddressFaxNumber": "231-946-1951",
"EnumerationDate": "07/15/2005",
"LastUpdateDate": "10/07/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STOCKWELL",
"AuthorizedOfficialFirstName": "TERI",
"AuthorizedOfficialMiddleName": "LORENCEN",
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "231-933-0100",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "2301007022",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}