{
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"IsOrgSubpart": "N",
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"OrgName": "BLUE STONE CHIROPRACTIC PS",
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"FirstLineMailingAddress": "620 KIRKLAND WAY",
"SecondLineMailingAddress": "STE 105",
"MailingAddressCityName": "KIRKLAND",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98033-6021",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "425-822-1859",
"MailingAddressFaxNumber": "425-822-2920",
"FirstLinePracticeLocationAddress": "620 KIRKLAND WAY",
"SecondLinePracticeLocationAddress": "SUITE 105",
"PracticeLocationAddressCityName": "KIRKLAND",
"PracticeLocationAddressStateName": "WA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "425-822-1859",
"PracticeLocationAddressFaxNumber": "425-822-2920",
"EnumerationDate": "08/29/2006",
"LastUpdateDate": "10/26/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TRAVERS",
"AuthorizedOfficialFirstName": "MARK",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "425-822-1859",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Chiropractor",
"LicenseNumber": "CH34314",
"LicenseNumberStateCode": "WA",
"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."
}
}
}
}