{
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"ParentOrgLBN": null,
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"LastName": null,
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"MiddleName": null,
"NamePrefix": null,
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"FirstLineMailingAddress": "205 W MAIN ST",
"SecondLineMailingAddress": "SUITE D",
"MailingAddressCityName": "ALLEN",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75013-8030",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "469-212-4548",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "205 W MAIN ST",
"SecondLinePracticeLocationAddress": "SUITE D",
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"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75013-8030",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "469-301-2151",
"PracticeLocationAddressFaxNumber": "469-301-2155",
"EnumerationDate": "01/29/2013",
"LastUpdateDate": "07/10/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STEPHEN",
"AuthorizedOfficialFirstName": "ADAM",
"AuthorizedOfficialMiddleName": "MATTHEW",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "469-301-2151",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "111N00000X",
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}
]
},
"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."
}
}
}
}