{
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"EIN": null,
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"IsOrgSubpart": "N",
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"ParentOrgTIN": null,
"OrgName": "TANZAR CHIROPRACTIC WELLCARE CENTER",
"LastName": null,
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"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1088 VISTA PARK DR",
"SecondLineMailingAddress": "SUITE C",
"MailingAddressCityName": "FOREST",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "24551-2761",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "434-385-1110",
"MailingAddressFaxNumber": "434-385-1115",
"FirstLinePracticeLocationAddress": "1088 VISTA PARK DR",
"SecondLinePracticeLocationAddress": "SUITE C",
"PracticeLocationAddressCityName": "FOREST",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "24551-2761",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "434-385-1110",
"PracticeLocationAddressFaxNumber": "434-385-1115",
"EnumerationDate": "01/29/2007",
"LastUpdateDate": "07/23/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TANZAR",
"AuthorizedOfficialFirstName": "JEFF",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C",
"AuthorizedOfficialTelephoneNumber": "434-385-1110",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "0104001938",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X 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."
}
}
}
}