{
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"FirstLineMailingAddress": "810 1ST ST S",
"SecondLineMailingAddress": "SUITE 110",
"MailingAddressCityName": "HOPKINS",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55343-8837",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "612-655-3073",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "810 1ST ST S",
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"PracticeLocationAddressTelephoneNumber": "612-655-3073",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/22/2009",
"LastUpdateDate": "05/20/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SAGEDAHL",
"AuthorizedOfficialFirstName": "ADAM",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "612-281-1116",
"Taxonomies": {
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"TaxonomyName": "Clinic/Center",
"LicenseNumber": "4501",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}