{
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"FirstLineMailingAddress": "321 HILLVIEW DR SE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MOUNT VERNON",
"MailingAddressStateName": "IA",
"MailingAddressPostalCode": "52314-9717",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "319-895-6392",
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"FirstLinePracticeLocationAddress": "216 2ND ST SW",
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"PracticeLocationAddressCityName": "MOUNT VERNON",
"PracticeLocationAddressStateName": "IA",
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"PracticeLocationAddressTelephoneNumber": "319-895-6392",
"PracticeLocationAddressFaxNumber": "319-895-6167",
"EnumerationDate": "01/11/2010",
"LastUpdateDate": "01/11/2010",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CORNELIUS",
"AuthorizedOfficialFirstName": "LARRY",
"AuthorizedOfficialMiddleName": "EDWARD",
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "319-895-6392",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X 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."
}
}
}
}