{
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"NPI": "1174927933",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BOWER CHIROPRACTIC INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "304 12TH AVE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NAMPA",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83686",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-466-0200",
"MailingAddressFaxNumber": "208-463-0649",
"FirstLinePracticeLocationAddress": "304 12TH AVE RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NAMPA",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83686",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-466-0200",
"PracticeLocationAddressFaxNumber": "208-463-0649",
"EnumerationDate": "10/22/2014",
"LastUpdateDate": "10/22/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BOWER",
"AuthorizedOfficialFirstName": "JACOB",
"AuthorizedOfficialMiddleName": "RAYMOND",
"AuthorizedOfficialTitle": "CHIROPRACTOR/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MS DC",
"AuthorizedOfficialTelephoneNumber": "208-466-0200",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111NS0005X",
"TaxonomyName": "Sports Physician Chiropractor",
"LicenseNumber": "CHIA-1618",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}