{
"Npi": {
"NPI": "1114278520",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MATHEW GROSE, D.C. CHIROPRACTIC INCORPORATION",
"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": "4502 MACCORKLE AVE SE",
"SecondLineMailingAddress": "SUITE B",
"MailingAddressCityName": "CHARLESTON",
"MailingAddressStateName": "WV",
"MailingAddressPostalCode": "25304-1835",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "304-925-1002",
"MailingAddressFaxNumber": "681-205-8382",
"FirstLinePracticeLocationAddress": "4502 MACCORKLE AVE SE",
"SecondLinePracticeLocationAddress": "SUITE B",
"PracticeLocationAddressCityName": "CHARLESTON",
"PracticeLocationAddressStateName": "WV",
"PracticeLocationAddressPostalCode": "25304-1835",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "304-925-1002",
"PracticeLocationAddressFaxNumber": "681-205-8382",
"EnumerationDate": "09/25/2012",
"LastUpdateDate": "09/25/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GROSE",
"AuthorizedOfficialFirstName": "MATHEW",
"AuthorizedOfficialMiddleName": "W",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "304-925-1002",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}