{
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"FirstLineMailingAddress": "417 WESTGATE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAFAYETTE",
"MailingAddressStateName": "LA",
"MailingAddressPostalCode": "70506-2720",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "337-232-6000",
"MailingAddressFaxNumber": "337-466-4868",
"FirstLinePracticeLocationAddress": "1811 REES ST UNIT C",
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"PracticeLocationAddressCityName": "BREAUX BRIDGE",
"PracticeLocationAddressStateName": "LA",
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"EnumerationDate": "11/10/2021",
"LastUpdateDate": "06/20/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HARGRAVE",
"AuthorizedOfficialFirstName": "CHRISTOPHER",
"AuthorizedOfficialMiddleName": "SETH",
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"AuthorizedOfficialCredential": "DC",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Chiropractor",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}