{
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"EIN": null,
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"ParentOrgLBN": null,
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"OrgName": "DR DOCTOR DISC INJURY AND SPINAL CARE CLINIC PC",
"LastName": null,
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"NamePrefix": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "1117 7TH AVE W",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BIRMINGHAM",
"MailingAddressStateName": "AL",
"MailingAddressPostalCode": "35204-3408",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "844-223-3737",
"MailingAddressFaxNumber": "844-373-7329",
"FirstLinePracticeLocationAddress": "1117 7TH AVE W",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BIRMINGHAM",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "844-223-3737",
"PracticeLocationAddressFaxNumber": "844-373-7329",
"EnumerationDate": "04/16/2014",
"LastUpdateDate": "04/16/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DOCTOR",
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"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "904-250-3737",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Medical Specialty Clinic/Center",
"LicenseNumber": "2346",
"LicenseNumberStateCode": "AL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}