{
"Npi": {
"NPI": "1285658104",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "STACEY",
"FirstName": "RONALD",
"MiddleName": "FRED",
"NamePrefix": "DR.",
"NameSuffix": "II",
"Credential": "D.C.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "8142 BELLARUS WAY STE 104",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TRINITY",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34655-1799",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "727-202-1303",
"MailingAddressFaxNumber": "727-835-7955",
"FirstLinePracticeLocationAddress": "8142 BELLARUS WAY STE 104",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TRINITY",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "34655-1799",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "727-202-1303",
"PracticeLocationAddressFaxNumber": "727-835-7955",
"EnumerationDate": "07/26/2006",
"LastUpdateDate": "12/05/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "CH9214",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}