{
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"FirstLineMailingAddress": "491 W BOURNE CIRCLE",
"SecondLineMailingAddress": "BUILDING 2 SUITE #1",
"MailingAddressCityName": "FARMINGTON",
"MailingAddressStateName": "UT",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "491 W BOURNE CIR STE 1",
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"PracticeLocationAddressCityName": "FARMINGTON",
"PracticeLocationAddressStateName": "UT",
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"EnumerationDate": "08/24/2017",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MAHONEY",
"AuthorizedOfficialFirstName": "KYLER",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CHIROPRACTOR",
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"AuthorizedOfficialCredential": "DC",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Chiropractor",
"LicenseNumber": "8666873-1202",
"LicenseNumberStateCode": "UT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}