{
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"EIN": null,
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"OrgName": "DR BRADLEY WOLFF D C A PROFESSIONAL CHIROPRACTIC CORPORATION",
"LastName": null,
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"OtherOrgNameTypeCode": "6",
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"FirstLineMailingAddress": "1900 E TAHQUITZ CANYON WAY",
"SecondLineMailingAddress": "C1",
"MailingAddressCityName": "PALM SPRINGS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92262-7024",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "760-327-3330",
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"FirstLinePracticeLocationAddress": "1900 E TAHQUITZ CANYON WAY STE C1",
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"PracticeLocationAddressCityName": "PALM SPRINGS",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-327-3330",
"PracticeLocationAddressFaxNumber": "760-327-3486",
"EnumerationDate": "05/12/2017",
"LastUpdateDate": "10/30/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WOLFF",
"AuthorizedOfficialFirstName": "BRADLEY",
"AuthorizedOfficialMiddleName": "EVAN",
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"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "760-327-3330",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Chiropractor",
"LicenseNumber": "DC18698",
"LicenseNumberStateCode": "CA",
"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."
}
}
}
}