{
"Npi": {
"NPI": "1487834156",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TOUCHBACK CHIROPRACTIC AND WELLNESS CENTER 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": "2443 MOCKINGBIRD LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GREEN BAY",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "54303-6275",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "920-246-8470",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "445 CARDINAL LN",
"SecondLinePracticeLocationAddress": "SUITE 106",
"PracticeLocationAddressCityName": "GREEN BAY",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "54313-9577",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "920-246-8470",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/09/2007",
"LastUpdateDate": "11/09/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "EMERSON",
"AuthorizedOfficialFirstName": "TUCKER",
"AuthorizedOfficialMiddleName": "ANTHONY",
"AuthorizedOfficialTitle": "CO-OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "920-246-8470",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "4342-012",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}