{
"Npi": {
"NPI": "1386816676",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ARMINAS WAGNER ENTERPRISES",
"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": "3900 W CHARLESTON BLVD",
"SecondLineMailingAddress": "SUITE 140",
"MailingAddressCityName": "LAS VEGAS",
"MailingAddressStateName": "NV",
"MailingAddressPostalCode": "89102-1628",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "702-310-5528",
"MailingAddressFaxNumber": "702-310-5549",
"FirstLinePracticeLocationAddress": "3900 W CHARLESTON BLVD",
"SecondLinePracticeLocationAddress": "SUITE 140",
"PracticeLocationAddressCityName": "LAS VEGAS",
"PracticeLocationAddressStateName": "NV",
"PracticeLocationAddressPostalCode": "89102-1628",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "702-310-5528",
"PracticeLocationAddressFaxNumber": "702-310-5549",
"EnumerationDate": "03/27/2008",
"LastUpdateDate": "01/11/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": "02/25/2009",
"NPIReactivationDate": "01/11/2010",
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WAGNER",
"AuthorizedOfficialFirstName": "ARMINAS",
"AuthorizedOfficialMiddleName": "S.",
"AuthorizedOfficialTitle": "DR./OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "702-310-5528",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "B00777",
"LicenseNumberStateCode": "NV",
"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."
}
}
}
}