{
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"FirstLineMailingAddress": "125 E MAIN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MORRISON",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "61270-2639",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "815-772-8069",
"MailingAddressFaxNumber": "815-772-9164",
"FirstLinePracticeLocationAddress": "125 E MAIN ST",
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"PracticeLocationAddressCityName": "MORRISON",
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"PracticeLocationAddressFaxNumber": "815-772-8084",
"EnumerationDate": "12/10/2014",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GAUMER",
"AuthorizedOfficialFirstName": "ERIC",
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"AuthorizedOfficialTitle": "DOCTOR",
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"AuthorizedOfficialCredential": "DC",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Chiropractor",
"LicenseNumber": "038-012732",
"LicenseNumberStateCode": "IL",
"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."
}
}
}
}