{
"Npi": {
"NPI": "1588046262",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CALTRIDER",
"FirstName": "COLBY",
"MiddleName": "DEEM",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "D.C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1639 SOUTHSIDE BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JACKSONVILLE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32216-1923",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "904-725-2286",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "309 KINGSLEY LAKE DR STE 901",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ST AUGUSTINE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32092-3048",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-999-8343",
"PracticeLocationAddressFaxNumber": "904-325-9049",
"EnumerationDate": "06/18/2015",
"LastUpdateDate": "12/16/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "CH11232",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "CH 11232",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}