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1174068019 NPI number — DESTIN CHIROPRACTIC, PLLC

NPI Number: 1174068019
Health Care Provider/Practitioner: DESTIN CHIROPRACTIC, PLLC

Information about “1174068019” NPI (DESTIN CHIROPRACTIC, PLLC) exists in 1174068019 in HTML format HTML  |  1174068019 in plain Text format TXT  |  1174068019 in PDF (Portable Document Format) PDF  |  1174068019 in an XML format XML  formats.

NPI Number : 1174068019 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1174068019",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "DESTIN CHIROPRACTIC, PLLC",
    "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": "4467 COMMONS DR W STE B",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DESTIN",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32541-8455",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4467 COMMONS DR W STE B",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DESTIN",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32541-8455",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "850-460-2333",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/02/2017",
    "LastUpdateDate": "01/02/2017",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "CLOWER",
    "AuthorizedOfficialFirstName": "KATHRYN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "COO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "D.C.",
    "AuthorizedOfficialTelephoneNumber": "850-460-2333",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "111N00000X",
          "TaxonomyName": "Chiropractor",
          "LicenseNumber": "CH11791",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "111N00000X",
          "TaxonomyName": "Chiropractor",
          "LicenseNumber": "CH11790",
          "LicenseNumberStateCode": "FL",
          "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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