{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "NIERMAN CHIROPRACTIC AND WELLNESS LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1921 HUGHES DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORT WAYNE",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "46816-3102",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "904-527-9601",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1921 HUGHES DR",
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"PracticeLocationAddressCityName": "FORT WAYNE",
"PracticeLocationAddressStateName": "IN",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-527-9601",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/15/2010",
"LastUpdateDate": "04/05/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NIERMAN",
"AuthorizedOfficialFirstName": "SHANNON",
"AuthorizedOfficialMiddleName": "LEE",
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"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "904-527-9601",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Clinic/Center",
"LicenseNumber": "08002640A",
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}