{
"Npi": {
"NPI": "1194953612",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ACTIVE LIFE CHIROPRACTIC AND ACUPUNCTURE, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "808 W BROWNING AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WOODLAND PARK",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80863-3319",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "719-687-7600",
"MailingAddressFaxNumber": "866-814-6742",
"FirstLinePracticeLocationAddress": "808 W BROWNING AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WOODLAND PARK",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80863-3319",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "719-687-7600",
"PracticeLocationAddressFaxNumber": "866-814-6742",
"EnumerationDate": "06/23/2009",
"LastUpdateDate": "06/23/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STEEN",
"AuthorizedOfficialFirstName": "CHERYL",
"AuthorizedOfficialMiddleName": "G.",
"AuthorizedOfficialTitle": "PRESIDENT/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "719-687-7600",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "4538",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}