NPI Code Detail JSON Logo

1316582042 NPI number — MAIN LINE INNTEGRATIVE AND FUNCTIONAL MEDICINE

NPI Number: 1316582042
Health Care Provider/Practitioner: MAIN LINE INNTEGRATIVE AND FUNCTIONAL MEDICINE

Information about “1316582042” NPI (MAIN LINE INNTEGRATIVE AND FUNCTIONAL MEDICINE) exists in 1316582042 in HTML format HTML  |  1316582042 in plain Text format TXT  |  1316582042 in PDF (Portable Document Format) PDF  |  1316582042 in an XML format XML  formats.

NPI Number : 1316582042 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1316582042",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "MAIN LINE INNTEGRATIVE AND FUNCTIONAL MEDICINE",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "45 E CITY AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BALA CYNWYD",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "19004-2421",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "484-254-6186",
    "MailingAddressFaxNumber": "202-891-4747",
    "FirstLinePracticeLocationAddress": "43 LE FORGE CT",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHESTERBROOK",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "19087-1223",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "484-254-6186",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/18/2019",
    "LastUpdateDate": "11/18/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "KALIE",
    "AuthorizedOfficialFirstName": "LORI",
    "AuthorizedOfficialMiddleName": "ANN",
    "AuthorizedOfficialTitle": "PRESIDENT & CEO",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DC",
    "AuthorizedOfficialTelephoneNumber": "484-254-6186",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "111NN1001X",
        "TaxonomyName": "Nutrition Chiropractor",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "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."
      }
    }
  }
}
                
            

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