{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CARROLL FAMILY CHIROPRACTIC CENTER",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 313",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CARROLL",
"MailingAddressStateName": "IA",
"MailingAddressPostalCode": "51401-0313",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "712-792-1763",
"MailingAddressFaxNumber": "712-792-5978",
"FirstLinePracticeLocationAddress": "726 N CARROLL ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CARROLL",
"PracticeLocationAddressStateName": "IA",
"PracticeLocationAddressPostalCode": "51401-2367",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "712-792-1763",
"PracticeLocationAddressFaxNumber": "712-792-5978",
"EnumerationDate": "06/16/2010",
"LastUpdateDate": "07/01/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHEBOSKI",
"AuthorizedOfficialFirstName": "MARY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "712-792-1763",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "A05363",
"LicenseNumberStateCode": "IA",
"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."
}
}
}
}