{
"Npi": {
"NPI": "1275803850",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SARAH FRANCES BUTLER FAN",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "12750 SW 2ND ST STE 102",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BEAVERTON",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97005-2779",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "503-877-5633",
"MailingAddressFaxNumber": "503-350-1470",
"FirstLinePracticeLocationAddress": "12750 SW 2ND ST STE 102",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BEAVERTON",
"PracticeLocationAddressStateName": "OR",
"PracticeLocationAddressPostalCode": "97005-2779",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "503-877-5633",
"PracticeLocationAddressFaxNumber": "503-350-1470",
"EnumerationDate": "01/12/2012",
"LastUpdateDate": "11/06/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FAN",
"AuthorizedOfficialFirstName": "SARAH",
"AuthorizedOfficialMiddleName": "FRANCES BUTLER",
"AuthorizedOfficialTitle": "SOLE PROPRIETOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LAC",
"AuthorizedOfficialTelephoneNumber": "503-877-5633",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "171100000X",
"TaxonomyName": "Acupuncturist",
"LicenseNumber": "153088",
"LicenseNumberStateCode": "OR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}