{
"Npi": {
"NPI": "1114133857",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "VAN AKEN HEALTH CENTER, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "20119 VAN AKEN BLVD",
"SecondLineMailingAddress": "SUITE 205",
"MailingAddressCityName": "SHAKER HEIGHTS",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "44122-3636",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "216-561-1994",
"MailingAddressFaxNumber": "216-561-0553",
"FirstLinePracticeLocationAddress": "20119 VAN AKEN BLVD",
"SecondLinePracticeLocationAddress": "SUITE 205",
"PracticeLocationAddressCityName": "SHAKER HEIGHTS",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "44122-3636",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "216-561-1994",
"PracticeLocationAddressFaxNumber": "216-561-0553",
"EnumerationDate": "05/16/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BROCCOLI",
"AuthorizedOfficialFirstName": "RAYMOND",
"AuthorizedOfficialMiddleName": "MICHAEL",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "216-561-1994",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "2432",
"LicenseNumberStateCode": "OH",
"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."
}
}
}
}