{
"Npi": {
"NPI": "1073751863",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BERMUDEZ CHIROPRACTIC CENTER, P.A.",
"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": "PO BOX 61",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ESTERO",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33929-0061",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "239-919-9899",
"MailingAddressFaxNumber": "239-313-5427",
"FirstLinePracticeLocationAddress": "4801 PALM BEACH BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FORT MYERS",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33905-3214",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "239-313-5427",
"PracticeLocationAddressFaxNumber": "239-313-5427",
"EnumerationDate": "02/02/2009",
"LastUpdateDate": "04/19/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BERMUDEZ",
"AuthorizedOfficialFirstName": "JACQUELINE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CHIROPRACTOR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "239-919-9899",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "302R00000X",
"TaxonomyName": "Health Maintenance Organization",
"LicenseNumber": "CH8963",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}