{
"Npi": {
"NPI": "1215383302",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KIPPEN",
"FirstName": "ABBY",
"MiddleName": "LEIGH",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "STAUSS KIPPEN",
"OtherFirstName": "ABBY",
"OtherMiddleName": "LEIGH",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "DC",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "2300 S ORCHARD ST STE A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BOISE",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83705-6722",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-383-3703",
"MailingAddressFaxNumber": "208-383-3702",
"FirstLinePracticeLocationAddress": "2300 S ORCHARD ST STE A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BOISE",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83705-6722",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-383-3703",
"PracticeLocationAddressFaxNumber": "208-383-3702",
"EnumerationDate": "05/09/2016",
"LastUpdateDate": "08/09/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "5739",
"LicenseNumberStateCode": "OR",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "CHIA1694",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}