{
"Npi": {
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SPORT AND SPINE CHIROPRACTIC CENTER LLC",
"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": "810 E HIGHWAY M",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WARRENTON",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "63383-2215",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "636-456-2966",
"MailingAddressFaxNumber": "636-456-2977",
"FirstLinePracticeLocationAddress": "810 E HIGHWAY M",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WARRENTON",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "63383-2215",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "636-456-2966",
"PracticeLocationAddressFaxNumber": "636-456-2977",
"EnumerationDate": "06/07/2010",
"LastUpdateDate": "06/07/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHARP",
"AuthorizedOfficialFirstName": "GINGER",
"AuthorizedOfficialMiddleName": "LEAH",
"AuthorizedOfficialTitle": "CFO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "636-456-2966",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "2006030811",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}