{
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"IsOrgSubpart": "N",
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"FirstLineMailingAddress": "251 N MAITLAND AVE",
"SecondLineMailingAddress": "SUITE 116",
"MailingAddressCityName": "ALTAMONTE SPRINGS",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32701-4914",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "407-647-2009",
"MailingAddressFaxNumber": "407-660-2009",
"FirstLinePracticeLocationAddress": "251 N MAITLAND AVE",
"SecondLinePracticeLocationAddress": "SUITE 116",
"PracticeLocationAddressCityName": "ALTAMONTE SPRINGS",
"PracticeLocationAddressStateName": "FL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "407-647-2009",
"PracticeLocationAddressFaxNumber": "407-660-2009",
"EnumerationDate": "03/23/2009",
"LastUpdateDate": "12/04/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROACH",
"AuthorizedOfficialFirstName": "ERIK",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT / CEO",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "407-647-2009",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111NN1001X",
"TaxonomyName": "Nutrition Chiropractor",
"LicenseNumber": "9409",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}