{
"Npi": {
"NPI": "1174762157",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HALIFAX SPINE CENTER",
"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": "117 SPRINGWOOD DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DAYTONA BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32119-1401",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1180 W GRANADA BLVD",
"SecondLinePracticeLocationAddress": "SUITE D",
"PracticeLocationAddressCityName": "ORMOND BEACH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32174-8165",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "386-290-9505",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/13/2009",
"LastUpdateDate": "02/13/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SMITH",
"AuthorizedOfficialFirstName": "HOLLY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MANAGING DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "386-290-9505",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QV0200X",
"TaxonomyName": "VA Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}