{
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"FirstLineMailingAddress": "712 N BLOOMINGTON ST",
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"MailingAddressCityName": "STREATOR",
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"MailingAddressPostalCode": "61364-2087",
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"MailingAddressTelephoneNumber": "815-672-6961",
"MailingAddressFaxNumber": "815-672-6891",
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"EnumerationDate": "09/07/2006",
"LastUpdateDate": "12/07/2015",
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "HERWIG",
"AuthorizedOfficialFirstName": "WILLIAM",
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"AuthorizedOfficialCredential": "DC",
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"Taxonomies": {
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"TaxonomyName": "Chiropractor",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}