{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "MARTINEZ FAMILY CHIROPRACTIC INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "8460 NUEVO AVE STE 4",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FONTANA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92335-3824",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "909-518-2607",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "8460 NUEVO AVE STE 4",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FONTANA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92335-3824",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "909-518-2607",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/31/2020",
"LastUpdateDate": "01/31/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MARTINEZ",
"AuthorizedOfficialFirstName": "JOSEPH",
"AuthorizedOfficialMiddleName": "R.",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "951-545-9280",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}