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1154713170 NPI number — SUMMIT CHIROPRACTIC CENTER LLC

NPI Number: 1154713170
Health Care Provider/Practitioner: SUMMIT CHIROPRACTIC CENTER LLC

Information about “1154713170” NPI (SUMMIT CHIROPRACTIC CENTER LLC) exists in 1154713170 in HTML format HTML  |  1154713170 in plain Text format TXT  |  1154713170 in PDF (Portable Document Format) PDF  |  1154713170 in an XML format XML  formats.

NPI Number : 1154713170 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1154713170",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SUMMIT CHIROPRACTIC CENTER LLC",
    "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": "69 CENTER RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ESSEX JUNCTION",
    "MailingAddressStateName": "VT",
    "MailingAddressPostalCode": "05452-2622",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "802-662-1047",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "69 CENTER RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ESSEX JUNCTION",
    "PracticeLocationAddressStateName": "VT",
    "PracticeLocationAddressPostalCode": "05452-2622",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "802-662-1047",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/27/2015",
    "LastUpdateDate": "03/10/2015",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "DUNKLOW",
    "AuthorizedOfficialFirstName": "TILYR",
    "AuthorizedOfficialMiddleName": "ALFRED",
    "AuthorizedOfficialTitle": "MANAGING MEMBER",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "D.C., B.S.",
    "AuthorizedOfficialTelephoneNumber": "802-662-1047",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "111N00000X",
          "TaxonomyName": "Chiropractor",
          "LicenseNumber": "006.0109165",
          "LicenseNumberStateCode": "VT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "111N00000X",
          "TaxonomyName": "Chiropractor",
          "LicenseNumber": "006.0109638",
          "LicenseNumberStateCode": "VT",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
        }
      ]
    }
  }
}
                
            

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