{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "BEACON OF HEALTH FAMILY CHIROPRACTIC AND NATURAL MEDICINE CENTER, INC.",
"LastName": null,
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"NamePrefix": null,
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"Credential": null,
"OtherOrgName": null,
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"FirstLineMailingAddress": "1956 MESQUITE AVE",
"SecondLineMailingAddress": "#103",
"MailingAddressCityName": "LAKE HAVASU CITY",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "86403-5888",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "928-854-8005",
"MailingAddressFaxNumber": "928-854-8006",
"FirstLinePracticeLocationAddress": "1956 MESQUITE AVE",
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"PracticeLocationAddressCityName": "LAKE HAVASU CITY",
"PracticeLocationAddressStateName": "AZ",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "928-854-8005",
"PracticeLocationAddressFaxNumber": "928-854-8006",
"EnumerationDate": "10/16/2012",
"LastUpdateDate": "10/07/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GARCIA",
"AuthorizedOfficialFirstName": "JENNIFER",
"AuthorizedOfficialMiddleName": "NICOLE RUSCH",
"AuthorizedOfficialTitle": "CHIROPRACTIC PHYSICIAN/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "928-854-8005",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "8291",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}