{
"Npi": {
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NEVILLE SPINAL BALANCE PLLC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2145 WEST BROADWAY STREET",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "IDAHO FALLS",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83402-2904",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-522-3130",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2145 WEST BROADWAY STREET",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "IDAHO FALLS",
"PracticeLocationAddressStateName": "ID",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-522-3130",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/17/2009",
"LastUpdateDate": "06/05/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NEVILLE",
"AuthorizedOfficialFirstName": "TREVER",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "208-522-3130",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "CHIA-1331",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}