{
"Npi": {
"NPI": "1427552397",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NEO CHIROPRACTIC UNITED POURARBAB INC",
"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": "16035 WIZARD WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "VALLEY CENTER",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92082-5326",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "619-228-2288",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "215 S HICKORY ST STE 116",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ESCONDIDO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92025-4360",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "619-228-2288",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/23/2018",
"LastUpdateDate": "03/23/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "POURARBAB",
"AuthorizedOfficialFirstName": "PEJMAN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DC,CPT",
"AuthorizedOfficialTelephoneNumber": "619-228-2288",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QR0400X",
"TaxonomyName": "Rehabilitation Clinic/Center",
"LicenseNumber": "7052",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QR0400X",
"TaxonomyName": "Rehabilitation Clinic/Center",
"LicenseNumber": "3729",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QR0400X",
"TaxonomyName": "Rehabilitation Clinic/Center",
"LicenseNumber": "32110",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}