{
"Npi": {
"NPI": "1164968640",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "ELLIOTT",
"FirstName": "DUSTIN",
"MiddleName": "DAVID",
"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": "757 E WYTHE CREEK CT STE 102",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KUNA",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83634-5006",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-922-4908",
"MailingAddressFaxNumber": "208-922-4909",
"FirstLinePracticeLocationAddress": "757 E WYTHE CREEK CT STE 102",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "KUNA",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83634-5006",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-922-4908",
"PracticeLocationAddressFaxNumber": "208-922-4909",
"EnumerationDate": "01/09/2017",
"LastUpdateDate": "01/09/2017",
"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": "CHIA-1734",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}