{
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"FirstLineMailingAddress": "107 RESERVE CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAINT MARYS",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31558-4278",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "308 JACKSON ST",
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"PracticeLocationAddressCityName": "VIDALIA",
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"EnumerationDate": "11/15/2012",
"LastUpdateDate": "11/15/2012",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ZUBECK",
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"AuthorizedOfficialTelephoneNumber": "912-585-7124",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Chiropractor",
"LicenseNumber": "CHIR008450",
"LicenseNumberStateCode": "GA",
"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."
}
}
}
}