{
"Npi": {
"NPI": "1447474010",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "ACTIVSTYLE HOLDING COMPANY",
"ParentOrgTIN": null,
"OrgName": "CHAMPLAIN VALLEY BRACE AND LIMB, L.L.C.",
"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": "1055 WESTGATE DR STE 100",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAINT PAUL",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55114-1451",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "888-280-8632",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "762 STATE ROUTE 3",
"SecondLinePracticeLocationAddress": "STE 15",
"PracticeLocationAddressCityName": "PLATTSBURGH",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "12901-7472",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "518-907-0225",
"PracticeLocationAddressFaxNumber": "518-561-5335",
"EnumerationDate": "04/12/2007",
"LastUpdateDate": "10/31/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RAWLINGS",
"AuthorizedOfficialFirstName": "DARRELL",
"AuthorizedOfficialMiddleName": "DOUGLAS",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "612-895-7815",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "332BP3500X",
"TaxonomyName": "Parenteral & Enteral Nutrition Supplies (DME)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}