{
"Npi": {
"NPI": "1124504840",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WEISS",
"FirstName": "MICHAEL",
"MiddleName": "JACOB",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "12087 CHURCH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BIRCH RUN",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48415-8758",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "989-860-8972",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "404 ROUNDS DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FENTON",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48430-1724",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "810-208-0424",
"PracticeLocationAddressFaxNumber": "866-227-3775",
"EnumerationDate": "07/16/2018",
"LastUpdateDate": "01/04/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "2301010627",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}