{
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"FirstLineMailingAddress": "1484 CLARMAR AVE W",
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"MailingAddressCityName": "ROSEVILLE",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55113-1608",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "612-331-9999",
"MailingAddressFaxNumber": "651-330-0826",
"FirstLinePracticeLocationAddress": "1484 CLARMAR AVE W",
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"PracticeLocationAddressFaxNumber": "651-330-0826",
"EnumerationDate": "07/09/2018",
"LastUpdateDate": "07/09/2018",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STAEHELI",
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"AuthorizedOfficialTitle": "MANAGING MEMBER",
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"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "612-840-2517",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Chiropractor",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}