{
"Npi": {
"NPI": "1467634428",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HEALTHY SPINE, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5800 SAMPSON DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GIRARD",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "44420-3513",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "330-759-0875",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1250 YOUNGSTOWN WARREN RD",
"SecondLinePracticeLocationAddress": "BLD 1, SUITE B",
"PracticeLocationAddressCityName": "NILES",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "44446-4649",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "330-652-4978",
"PracticeLocationAddressFaxNumber": "330-652-4994",
"EnumerationDate": "12/02/2007",
"LastUpdateDate": "12/02/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FERRARA",
"AuthorizedOfficialFirstName": "JEREMIAH",
"AuthorizedOfficialMiddleName": "JOSEPH",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "330-759-0875",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "3538",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
}
}
}