{
"Npi": {
"NPI": "1144558727",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TMJ TX CLINIC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "8649 REGENCY PARK BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PORT RICHEY",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34668-5742",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "727-843-4035",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "8649 REGENCY PARK BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PORT RICHEY",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "34668-5742",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "727-813-0475",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/19/2009",
"LastUpdateDate": "11/19/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHANCEY",
"AuthorizedOfficialFirstName": "INA",
"AuthorizedOfficialMiddleName": "MARIE",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MS/CCC/SLP",
"AuthorizedOfficialTelephoneNumber": "727-813-0475",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "SA 1638",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}