{
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"EIN": null,
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"OrgName": "MAROTTA HEALTH AND WELLNESS CHIROPRACTIC PLLC",
"LastName": null,
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"MiddleName": null,
"NamePrefix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "939 ROUTE 146",
"SecondLineMailingAddress": "#230",
"MailingAddressCityName": "CLIFTON PARK",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "12065-3662",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "518-357-3347",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "939 ROUTE 146",
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"PracticeLocationAddressCityName": "CLIFTON PARK",
"PracticeLocationAddressStateName": "NY",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "518-357-3347",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/20/2008",
"LastUpdateDate": "01/28/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MAROTTA",
"AuthorizedOfficialFirstName": "ANTONIO",
"AuthorizedOfficialMiddleName": "VR",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "518-357-3347",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "X011500",
"LicenseNumberStateCode": "NY",
"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."
}
}
}
}