{
"Npi": {
"NPI": "1265680094",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JACK V. WATERS, D.C., P.C.",
"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": "1833 W 21ST ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CLOVIS",
"MailingAddressStateName": "NM",
"MailingAddressPostalCode": "88101-4023",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "575-763-8888",
"MailingAddressFaxNumber": "575-763-8891",
"FirstLinePracticeLocationAddress": "1833 W 21ST ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CLOVIS",
"PracticeLocationAddressStateName": "NM",
"PracticeLocationAddressPostalCode": "88101-4023",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "575-763-8888",
"PracticeLocationAddressFaxNumber": "575-763-8891",
"EnumerationDate": "09/04/2008",
"LastUpdateDate": "12/10/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WATERS",
"AuthorizedOfficialFirstName": "JACK",
"AuthorizedOfficialMiddleName": "V.",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "575-763-8888",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "989",
"LicenseNumberStateCode": "NM",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}