{
"Npi": {
"NPI": "1588926091",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COLLINS CHIROPRACTIC & DIAGNOSTICS",
"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": "903 NW 9TH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BENTONVILLE",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "72712-4501",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "479-254-9355",
"MailingAddressFaxNumber": "479-254-9360",
"FirstLinePracticeLocationAddress": "903 NW 9TH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BENTONVILLE",
"PracticeLocationAddressStateName": "AR",
"PracticeLocationAddressPostalCode": "72712-4501",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "479-254-9355",
"PracticeLocationAddressFaxNumber": "479-254-9360",
"EnumerationDate": "06/11/2012",
"LastUpdateDate": "06/11/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COLLINS",
"AuthorizedOfficialFirstName": "JASON",
"AuthorizedOfficialMiddleName": "MICHAEL",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "479-254-9355",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "1532",
"LicenseNumberStateCode": "AR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}