{
"Npi": {
"NPI": "1578915401",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BIOSPINE HEALTH AND WELNESS, 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": "542 BEN GAUSE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COWARD",
"MailingAddressStateName": "SC",
"MailingAddressPostalCode": "29530-5127",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "843-940-0687",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "542 BEN GAUSE RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "COWARD",
"PracticeLocationAddressStateName": "SC",
"PracticeLocationAddressPostalCode": "29530-5127",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "843-940-0687",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/03/2016",
"LastUpdateDate": "07/03/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JORDAN",
"AuthorizedOfficialFirstName": "CHUCKY",
"AuthorizedOfficialMiddleName": "SENTELL",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "843-940-0687",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QH0100X",
"TaxonomyName": "Health Service Clinic/Center",
"LicenseNumber": "SC 4099",
"LicenseNumberStateCode": "SC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}