{
"Npi": {
"NPI": "1265465058",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BALANCED SPINE LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "22525 SE 64TH PL",
"SecondLineMailingAddress": "SUITE 110",
"MailingAddressCityName": "ISSAQUAH",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98027-5383",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "425-369-1040",
"MailingAddressFaxNumber": "425-369-1041",
"FirstLinePracticeLocationAddress": "22525 SE 64TH PL",
"SecondLinePracticeLocationAddress": "SUITE 110",
"PracticeLocationAddressCityName": "ISSAQUAH",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98027-5383",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "425-369-1040",
"PracticeLocationAddressFaxNumber": "425-369-1041",
"EnumerationDate": "07/08/2006",
"LastUpdateDate": "06/08/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FRYER",
"AuthorizedOfficialFirstName": "SEAN",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "MANAGING MEMBER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "425-369-1040",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "CH00034301",
"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."
}
}
}
}