{
"Npi": {
"NPI": "1538400031",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COVINGTON CHIROPRACTIC LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "26708 180TH AVE SE",
"SecondLineMailingAddress": "SUITE102",
"MailingAddressCityName": "COVINGTON",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98042-4969",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "253-630-9777",
"MailingAddressFaxNumber": "253-630-9806",
"FirstLinePracticeLocationAddress": "26708 180TH AVE SE",
"SecondLinePracticeLocationAddress": "SUITE102",
"PracticeLocationAddressCityName": "COVINGTON",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98042-4969",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "253-630-9777",
"PracticeLocationAddressFaxNumber": "253-630-9806",
"EnumerationDate": "03/07/2013",
"LastUpdateDate": "03/07/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VITALIS",
"AuthorizedOfficialFirstName": "NEAL",
"AuthorizedOfficialMiddleName": "BOOHER",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C",
"AuthorizedOfficialTelephoneNumber": "253-630-9777",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "CH00002179",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}