{
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"OrgName": "REMEDY",
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"FirstLineMailingAddress": "4224 NE HALSEY ST",
"SecondLineMailingAddress": "SUITE 325",
"MailingAddressCityName": "PORTLAND",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97213-1538",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "503-505-6181",
"MailingAddressFaxNumber": "503-820-0273",
"FirstLinePracticeLocationAddress": "4224 NE HALSEY ST",
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"PracticeLocationAddressFaxNumber": "503-820-0273",
"EnumerationDate": "04/08/2013",
"LastUpdateDate": "04/08/2013",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHERVENY",
"AuthorizedOfficialFirstName": "JOHN",
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"AuthorizedOfficialTitle": "DOCTOR OF CHIROPRACTIC",
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"AuthorizedOfficialCredential": "DC",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225700000X",
"TaxonomyName": "Massage Therapist",
"LicenseNumber": "17201",
"LicenseNumberStateCode": "OR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}