{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "HEALTH FULL ELEMENTS",
"LastName": null,
"FirstName": null,
"MiddleName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "25797 CURIE AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WARREN",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48091-3829",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "586-216-0990",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "11443 E 13 MILE RD",
"SecondLinePracticeLocationAddress": "404",
"PracticeLocationAddressCityName": "WARREN",
"PracticeLocationAddressStateName": "MI",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "586-216-0990",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/05/2015",
"LastUpdateDate": "08/05/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JAKUBOWSKI",
"AuthorizedOfficialFirstName": "DAWN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER; MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MT",
"AuthorizedOfficialTelephoneNumber": "586-216-0990",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Contractor",
"LicenseNumber": "7501004559",
"LicenseNumberStateCode": "MI",
"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."
}
}
}
}