{
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"FirstLineMailingAddress": "1544 W WINDY WILLOW DR",
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"MailingAddressCityName": "ST AUGUSTINE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32092-5098",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "13241 BARTRAM PARK BLVD UNIT 2501",
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"PracticeLocationAddressCityName": "JACKSONVILLE",
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"PracticeLocationAddressTelephoneNumber": "561-843-7654",
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"EnumerationDate": "12/14/2017",
"LastUpdateDate": "03/20/2019",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BUSQUETS",
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"AuthorizedOfficialCredential": "DC",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Chiropractor",
"LicenseNumber": "CH12201",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}