{
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"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "27104 DEQUINDRE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WARREN",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48092-3537",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "586-751-1977",
"MailingAddressFaxNumber": "586-751-1929",
"FirstLinePracticeLocationAddress": "27104 DEQUINDRE RD",
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"PracticeLocationAddressCityName": "WARREN",
"PracticeLocationAddressStateName": "MI",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "586-751-1977",
"PracticeLocationAddressFaxNumber": "586-751-1929",
"EnumerationDate": "01/26/2007",
"LastUpdateDate": "11/28/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LOGAN",
"AuthorizedOfficialFirstName": "BILL",
"AuthorizedOfficialMiddleName": "ALAN",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "D.C",
"AuthorizedOfficialTelephoneNumber": "586-751-1977",
"Taxonomies": {
"Taxonomy": [
{
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"TaxonomyName": "Chiropractor",
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"PrimaryTaxonomySwitch": "N"
},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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{
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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."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
]
}
}
}