{
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"EIN": null,
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"IsOrgSubpart": "N",
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"ParentOrgTIN": null,
"OrgName": "CHIROPRACTIC CONCIERGE",
"LastName": null,
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"NamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "11443 MARIPOE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WEEKI WACHEE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34614-3507",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "828-582-1403",
"MailingAddressFaxNumber": "813-444-3193",
"FirstLinePracticeLocationAddress": "11443 MARIPOE RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WEEKI WACHEE",
"PracticeLocationAddressStateName": "FL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "828-582-1403",
"PracticeLocationAddressFaxNumber": "813-444-3193",
"EnumerationDate": "10/15/2015",
"LastUpdateDate": "10/19/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ALLEN",
"AuthorizedOfficialFirstName": "JESSICA",
"AuthorizedOfficialMiddleName": "MARIE",
"AuthorizedOfficialTitle": "OWNER/PHYSICIAN",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "828-582-1403",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "CH11214",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"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."
}
}
}
}