{
"Npi": {
"NPI": "1376970202",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TEXARKANA HEALTH AND WELLNESS, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1718 RICHMOND RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TEXARKANA",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75503-2415",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "903-838-5883",
"MailingAddressFaxNumber": "903-223-9075",
"FirstLinePracticeLocationAddress": "1718 RICHMOND RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TEXARKANA",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75503-2415",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "903-838-5883",
"PracticeLocationAddressFaxNumber": "903-223-9075",
"EnumerationDate": "10/09/2013",
"LastUpdateDate": "08/21/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MCDOUGAL",
"AuthorizedOfficialFirstName": "MIA",
"AuthorizedOfficialMiddleName": "ADAMS",
"AuthorizedOfficialTitle": "CHIROPRACTOR",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "903-838-5883",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "305R00000X",
"TaxonomyName": "Preferred Provider Organization",
"LicenseNumber": "11844",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}