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1093143109 NPI number — MC INTEGRATIVE MEDICINE, LLC

NPI Number: 1093143109
Health Care Provider/Practitioner: MC INTEGRATIVE MEDICINE, LLC

Information about “1093143109” NPI (MC INTEGRATIVE MEDICINE, LLC) exists in 1093143109 in HTML format HTML  |  1093143109 in plain Text format TXT  |  1093143109 in PDF (Portable Document Format) PDF  |  1093143109 in an XML format XML  formats.

NPI Number : 1093143109 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1093143109",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "MC INTEGRATIVE MEDICINE, 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": "4450 WESTBROOK DR",
    "SecondLineMailingAddress": "SUITE 100",
    "MailingAddressCityName": "AURORA",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60504-7936",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "331-444-2284",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4450 WESTBROOK DR",
    "SecondLinePracticeLocationAddress": "SUITE 100",
    "PracticeLocationAddressCityName": "AURORA",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60504-7936",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "331-444-2284",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/29/2013",
    "LastUpdateDate": "10/29/2013",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "VERHAGEN",
    "AuthorizedOfficialFirstName": "MELISSA",
    "AuthorizedOfficialMiddleName": "C",
    "AuthorizedOfficialTitle": "OWNER - DC",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DC",
    "AuthorizedOfficialTelephoneNumber": "331-444-2284",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "111N00000X",
        "TaxonomyName": "Chiropractor",
        "LicenseNumber": "038012420",
        "LicenseNumberStateCode": "IL",
        "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."
      }
    }
  }
}
                
            

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