{
"Npi": {
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NORTHERN ARIZONA SPINAL CARE, PLLC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2225 E 7TH AVE",
"SecondLineMailingAddress": "SUITE A AND B",
"MailingAddressCityName": "FLAGSTAFF",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "86004",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "928-226-9195",
"MailingAddressFaxNumber": "928-226-9167",
"FirstLinePracticeLocationAddress": "2225 E 7TH AVE",
"SecondLinePracticeLocationAddress": "SUITE A AND B",
"PracticeLocationAddressCityName": "FLAGSTAFF",
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"PracticeLocationAddressPostalCode": "86004",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "928-226-9195",
"PracticeLocationAddressFaxNumber": "928-226-9167",
"EnumerationDate": "10/18/2006",
"LastUpdateDate": "06/25/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BENNETT",
"AuthorizedOfficialFirstName": "KAI",
"AuthorizedOfficialMiddleName": "M G",
"AuthorizedOfficialTitle": "OWNER DOCTOR OG CHIROPRACTIC",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "928-226-9195",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Chiropractor",
"LicenseNumber": "6006",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}