{
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"FirstLineMailingAddress": "14290 SULLYFIELD CIR",
"SecondLineMailingAddress": "SUITE 100",
"MailingAddressCityName": "CHANTILLY",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "20151-4000",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "703-467-0177",
"MailingAddressFaxNumber": "571-308-2559",
"FirstLinePracticeLocationAddress": "14290 SULLYFIELD CIR",
"SecondLinePracticeLocationAddress": "SUITE 100",
"PracticeLocationAddressCityName": "CHANTILLY",
"PracticeLocationAddressStateName": "VA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "703-467-0177",
"PracticeLocationAddressFaxNumber": "571-308-2559",
"EnumerationDate": "09/11/2012",
"LastUpdateDate": "08/22/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JEONG",
"AuthorizedOfficialFirstName": "TAEJOO",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "703-467-0177",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "0104556735",
"LicenseNumberStateCode": "VA",
"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."
}
}
}
}