{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 95",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WESTFIELD",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53964-0095",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "608-296-2717",
"MailingAddressFaxNumber": "608-296-2643",
"FirstLinePracticeLocationAddress": "128 EAST 2ND STREET",
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"PracticeLocationAddressCityName": "WESTFIELD",
"PracticeLocationAddressStateName": "WI",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "608-296-2717",
"PracticeLocationAddressFaxNumber": "608-296-2643",
"EnumerationDate": "02/01/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WRIGHT",
"AuthorizedOfficialFirstName": "DARRELL",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "BUSINESS MANAGER",
"AuthorizedOfficialNamePrefix": "MR.",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "608-296-2717",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
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"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "111N00000X",
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}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
]
}
}
}