{
"Npi": {
"NPI": "1538244769",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BLACKWELDER CHIROPRACTIC, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "25762 VIA DEL REY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN JUAN CAPISTRANO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92675-4444",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "949-240-0483",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "24721 LA PLZ",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DANA POINT",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92629-2509",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "949-240-2546",
"PracticeLocationAddressFaxNumber": "949-240-3804",
"EnumerationDate": "10/26/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BLACKWELDER",
"AuthorizedOfficialFirstName": "CLYDE",
"AuthorizedOfficialMiddleName": "SPENCER",
"AuthorizedOfficialTitle": "PRESIDENT/ OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "949-240-2546",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "DC23746",
"LicenseNumberStateCode": "CA",
"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."
}
}
}
}