{
"Npi": {
"NPI": "1164821963",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SPORT AND SPINE CHIROPRACTIC PC",
"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": "19 BAY RIDGE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SCITUATE",
"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "02066-3501",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "781-741-5300",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "185 LINCOLN ST",
"SecondLinePracticeLocationAddress": "#110",
"PracticeLocationAddressCityName": "HINGHAM",
"PracticeLocationAddressStateName": "MA",
"PracticeLocationAddressPostalCode": "02043-1743",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "781-741-5300",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/18/2014",
"LastUpdateDate": "11/04/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "REES",
"AuthorizedOfficialFirstName": "LOREN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "741-741-5300",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "3059",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "111NS0005X",
"TaxonomyName": "Sports Physician Chiropractor",
"LicenseNumber": "3059",
"LicenseNumberStateCode": "MA",
"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."
}
]
}
}
}