{
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"OrgName": "NATIVE SOUL CHIROPRACTIC LLC",
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"FirstLineMailingAddress": "PO BOX 270",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FARMINGTON",
"MailingAddressStateName": "NM",
"MailingAddressPostalCode": "87499-0270",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "505-327-7476",
"MailingAddressFaxNumber": "505-327-7389",
"FirstLinePracticeLocationAddress": "737 W ARRINGTON ST",
"SecondLinePracticeLocationAddress": "SUITE C",
"PracticeLocationAddressCityName": "FARMINGTON",
"PracticeLocationAddressStateName": "NM",
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"PracticeLocationAddressTelephoneNumber": "505-327-7476",
"PracticeLocationAddressFaxNumber": "505-327-7389",
"EnumerationDate": "04/25/2008",
"LastUpdateDate": "04/25/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KIRBY",
"AuthorizedOfficialFirstName": "KENNETH",
"AuthorizedOfficialMiddleName": "A",
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"AuthorizedOfficialCredential": "DC",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "1691",
"LicenseNumberStateCode": "NM",
"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."
}
}
}
}