{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "LAKELAND SPORTS PERFORMANCE INC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5151 S LAKELAND DR",
"SecondLineMailingAddress": "SUITE 6",
"MailingAddressCityName": "LAKELAND",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33813-2518",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "863-646-3388",
"MailingAddressFaxNumber": "863-646-3380",
"FirstLinePracticeLocationAddress": "5151 S LAKELAND DR",
"SecondLinePracticeLocationAddress": "SUITE 6",
"PracticeLocationAddressCityName": "LAKELAND",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33813-2518",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "863-646-3388",
"PracticeLocationAddressFaxNumber": "863-646-3380",
"EnumerationDate": "10/23/2006",
"LastUpdateDate": "03/26/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ZAMZOW",
"AuthorizedOfficialFirstName": "JOSEPH",
"AuthorizedOfficialMiddleName": "ALLEN",
"AuthorizedOfficialTitle": "COO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "863-646-3388",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "CH8827",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}