{
"Npi": {
"NPI": "1508070467",
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "TLC FAMILY CHIROPRACTIC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherNamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "430 N STATE ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RIGBY",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83442-1240",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-745-8760",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "430 N STATE ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RIGBY",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83442-1240",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-745-8760",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/10/2007",
"LastUpdateDate": "01/26/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MCCUISTION",
"AuthorizedOfficialFirstName": "TRACY",
"AuthorizedOfficialMiddleName": "ARTHUR",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "801-502-9278",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "3449671202",
"LicenseNumberStateCode": "UT",
"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."
}
}
}
}