{
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"IsOrgSubpart": "N",
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"OrgName": "DYNAMIC CHIROPRACTIC & WELLNESS CENTER",
"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "211 W HIGHWAY 19",
"SecondLineMailingAddress": "PO BOX 148",
"MailingAddressCityName": "MARTINSBURG",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "65264-2013",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "573-492-6065",
"MailingAddressFaxNumber": "573-492-6065",
"FirstLinePracticeLocationAddress": "211 W HIGHWAY 19",
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"PracticeLocationAddressCityName": "MARTINSBURG",
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"PracticeLocationAddressTelephoneNumber": "573-492-6065",
"PracticeLocationAddressFaxNumber": "573-492-6065",
"EnumerationDate": "11/12/2009",
"LastUpdateDate": "11/12/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ZINDRICK",
"AuthorizedOfficialFirstName": "COURTNEY",
"AuthorizedOfficialMiddleName": "KAY",
"AuthorizedOfficialTitle": "OWNER/PHYSICIAN",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "573-492-6065",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "2009014528",
"LicenseNumberStateCode": "MO",
"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."
}
}
}
}