{
"Npi": {
"NPI": "1073824082",
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"ReplacementNPI": null,
"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ROCHESTER SPINE & SPORTS CHIROPRACTIC, PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "135 SULLYS TRL STE 5",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PITTSFORD",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "14534-4564",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "585-678-1362",
"MailingAddressFaxNumber": "585-348-9102",
"FirstLinePracticeLocationAddress": "135 SULLYS TRL STE 5",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PITTSFORD",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "14534-4564",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "585-678-1362",
"PracticeLocationAddressFaxNumber": "585-348-9102",
"EnumerationDate": "06/24/2010",
"LastUpdateDate": "12/30/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BUFFAN",
"AuthorizedOfficialFirstName": "MATTHEW",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "MANAGING MEMBER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "585-678-1362",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "011867",
"LicenseNumberStateCode": "NY",
"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."
}
}
}
}