{
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"OrgName": "CHIROPRACTIC TLC PC",
"LastName": null,
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"FirstLineMailingAddress": "PO BOX 305",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NORTH LIBERTY",
"MailingAddressStateName": "IA",
"MailingAddressPostalCode": "52317-0305",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "319-665-9066",
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"FirstLinePracticeLocationAddress": "1295 JORDAN ST",
"SecondLinePracticeLocationAddress": "STE. 6",
"PracticeLocationAddressCityName": "NORTH LIBERTY",
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"EnumerationDate": "04/10/2008",
"LastUpdateDate": "06/26/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MESCH",
"AuthorizedOfficialFirstName": "ROBERT",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "319-665-9066",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Chiropractor",
"LicenseNumber": "06774",
"LicenseNumberStateCode": "IA",
"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."
}
}
}
}