{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JORDAN CHAUSSE LLC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"OtherOrgName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "81 RIVERSIDE DR",
"SecondLineMailingAddress": "SUITE 1",
"MailingAddressCityName": "LEBANON",
"MailingAddressStateName": "NH",
"MailingAddressPostalCode": "03766-2033",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "603-443-9639",
"MailingAddressFaxNumber": "603-443-9659",
"FirstLinePracticeLocationAddress": "81 RIVERSIDE DR",
"SecondLinePracticeLocationAddress": "SUITE 1",
"PracticeLocationAddressCityName": "LEBANON",
"PracticeLocationAddressStateName": "NH",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "603-443-9639",
"PracticeLocationAddressFaxNumber": "603-443-9659",
"EnumerationDate": "01/21/2016",
"LastUpdateDate": "01/21/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHAUSSE",
"AuthorizedOfficialFirstName": "THERESA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "603-443-9639",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QX0100X",
"TaxonomyName": "Occupational Medicine Clinic/Center",
"LicenseNumber": "647013",
"LicenseNumberStateCode": "NH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}