{
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"FirstLineMailingAddress": "171 S ORLANDO AVE STE A",
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"MailingAddressCityName": "MAITLAND",
"MailingAddressStateName": "FL",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "171 S ORLANDO AVE STE A",
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"PracticeLocationAddressCityName": "MAITLAND",
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"PracticeLocationAddressCountryCode": "US",
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"EnumerationDate": "04/04/2018",
"LastUpdateDate": "05/13/2023",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Chiropractor",
"LicenseNumber": "CH12454",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
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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."
}
}
}
}