{
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"FirstLineMailingAddress": "6030 GARRETT LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ROCKFORD",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "61107-6637",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "815-398-4004",
"MailingAddressFaxNumber": "815-398-4005",
"FirstLinePracticeLocationAddress": "6030 GARRETT LN",
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"PracticeLocationAddressCityName": "ROCKFORD",
"PracticeLocationAddressStateName": "IL",
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"PracticeLocationAddressCountryCode": "US",
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"PracticeLocationAddressFaxNumber": "815-398-4005",
"EnumerationDate": "12/29/2006",
"LastUpdateDate": "12/26/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MYERS",
"AuthorizedOfficialFirstName": "LANCE",
"AuthorizedOfficialMiddleName": "AVERY",
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"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "815-398-4004",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Orthopedic Chiropractor",
"LicenseNumber": "038-005798",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}