{
"Npi": {
"NPI": "1396017331",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JAY CHIROPRACTIC CENTER",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3927 HIGHWAY 4",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JAY",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32565-1752",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "850-675-6886",
"MailingAddressFaxNumber": "850-675-6886",
"FirstLinePracticeLocationAddress": "5035 SAINTS LN",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MILTON",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32570-4046",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "850-748-0740",
"PracticeLocationAddressFaxNumber": "850-675-6886",
"EnumerationDate": "02/07/2012",
"LastUpdateDate": "02/07/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KEENUM",
"AuthorizedOfficialFirstName": "BERNARD",
"AuthorizedOfficialMiddleName": "JOSEPH",
"AuthorizedOfficialTitle": "OWNER/CHIROPRACTIC PHYSICIAN",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "850-675-6886",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "305R00000X",
"TaxonomyName": "Preferred Provider Organization",
"LicenseNumber": "CH0009285",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}