{
"Npi": {
"NPI": "1578947032",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PINNACLE CHIROPRACTIC & WELLNESS CENTER",
"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": "4635 SOUTHWEST FWY",
"SecondLineMailingAddress": "#715",
"MailingAddressCityName": "HOUSTON",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "77027-7169",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "832-687-9404",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3102 BIRCH LANDING CT",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PEARLAND",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "77584-6810",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "832-687-9404",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/15/2015",
"LastUpdateDate": "07/15/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BROUSSARD",
"AuthorizedOfficialFirstName": "TELLIS",
"AuthorizedOfficialMiddleName": "D",
"AuthorizedOfficialTitle": "CHIROPRACTOR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "832-687-9404",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "120109",
"LicenseNumberStateCode": "TX",
"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."
}
}
}
}