{
"Npi": {
"NPI": "1629326871",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MORITKO CHIROPRACTIC, P.A.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "810 LILAC DR N",
"SecondLineMailingAddress": "#210",
"MailingAddressCityName": "GOLDEN VALLEY",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55422-4656",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "763-205-5519",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "810 LILAC DR N",
"SecondLinePracticeLocationAddress": "#120",
"PracticeLocationAddressCityName": "GOLDEN VALLEY",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55422-4656",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "763-588-5000",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/20/2012",
"LastUpdateDate": "08/20/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MORITKO",
"AuthorizedOfficialFirstName": "LAWRENCE",
"AuthorizedOfficialMiddleName": "EDWARD",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "763-588-7000",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "3064",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}