{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "NEENAH CHIROPRACTIC & REHAB INC",
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"NamePrefix": null,
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"FirstLineMailingAddress": "907 TULLAR RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NEENAH",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "54956-3617",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "920-722-9200",
"MailingAddressFaxNumber": "920-722-9202",
"FirstLinePracticeLocationAddress": "907 TULLAR RD",
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"PracticeLocationAddressCityName": "NEENAH",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "920-722-9200",
"PracticeLocationAddressFaxNumber": "920-722-9202",
"EnumerationDate": "10/16/2007",
"LastUpdateDate": "01/15/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BOGAART",
"AuthorizedOfficialFirstName": "ERIC",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "920-722-9200",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "4143012",
"LicenseNumberStateCode": "WI",
"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."
}
}
}
}