{
"Npi": {
"NPI": "1164813614",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SHAKLEY CHIROPRACTIC AND WELLNESS 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": "185 HARRY S TRUMAN PKWY STE 100",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ANNAPOLIS",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21401-7580",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "410-263-4171",
"MailingAddressFaxNumber": "410-263-4275",
"FirstLinePracticeLocationAddress": "185 HARRY S TRUMAN PKWY STE 100",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ANNAPOLIS",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "21401-7580",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "410-263-4171",
"PracticeLocationAddressFaxNumber": "410-263-4275",
"EnumerationDate": "02/05/2015",
"LastUpdateDate": "05/03/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHAKLEY",
"AuthorizedOfficialFirstName": "RYAN",
"AuthorizedOfficialMiddleName": "DALE",
"AuthorizedOfficialTitle": "DOCTOR/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "410-251-8572",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "S03565",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}