{
"Npi": {
"NPI": "1619121936",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TABOR CHIROPRACTIC &REHABILITATION LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
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"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3 HOVTECH BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MOUNT LAUREL",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "08054-6306",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "856-235-0202",
"MailingAddressFaxNumber": "856-235-3377",
"FirstLinePracticeLocationAddress": "1335 W TABOR RD",
"SecondLinePracticeLocationAddress": "SUITE 306",
"PracticeLocationAddressCityName": "PHILADELPHIA",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "19141-3038",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "215-549-5810",
"PracticeLocationAddressFaxNumber": "215-549-5869",
"EnumerationDate": "11/13/2008",
"LastUpdateDate": "11/13/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BARTASIUS",
"AuthorizedOfficialFirstName": "STEVEN",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "OWNER/DR.",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DO",
"AuthorizedOfficialTelephoneNumber": "215-549-5810",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111NR0400X",
"TaxonomyName": "Rehabilitation Chiropractor",
"LicenseNumber": "DC007418L",
"LicenseNumberStateCode": "PA",
"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."
}
}
}
}