{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "FIRE OF LIFE CHIROPRACTIC PLLC",
"LastName": null,
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"NameSuffix": null,
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"FirstLineMailingAddress": "1200 LAKEWAY DR",
"SecondLineMailingAddress": "17B",
"MailingAddressCityName": "LAKEWAY",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78734-4400",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "512-608-9121",
"MailingAddressFaxNumber": "512-608-9121",
"FirstLinePracticeLocationAddress": "1200 LAKEWAY DR",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "512-608-9121",
"PracticeLocationAddressFaxNumber": "512-608-9121",
"EnumerationDate": "11/27/2007",
"LastUpdateDate": "07/31/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "EDEKER",
"AuthorizedOfficialFirstName": "KURT",
"AuthorizedOfficialMiddleName": "VANESSA",
"AuthorizedOfficialTitle": "OFFICE MANAGER",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "512-608-9121",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "9962",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}