{
"Npi": {
"NPI": "1316038680",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GUNNERSON CHIROPRACTIC INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1325 NW 4TH ST STE 200",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GRAND RAPIDS",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55744-2209",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "218-326-4022",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1325 NW 4TH ST STE 200",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GRAND RAPIDS",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55744-2209",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "218-326-4022",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/28/2006",
"LastUpdateDate": "11/29/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GUNNERSON",
"AuthorizedOfficialFirstName": "LANE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "218-326-4022",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "3335",
"LicenseNumberStateCode": "MN",
"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."
}
}
}
}