{
"Npi": {
"NPI": "1649514969",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "J N BRODBECK DC PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5976 ROUTE 25A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WADING RIVER",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11792-2001",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "631-345-3035",
"MailingAddressFaxNumber": "631-345-3244",
"FirstLinePracticeLocationAddress": "5976 ROUTE 25A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WADING RIVER",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11792-2001",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "631-345-3035",
"PracticeLocationAddressFaxNumber": "631-345-3244",
"EnumerationDate": "11/27/2012",
"LastUpdateDate": "06/01/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BRODBECK",
"AuthorizedOfficialFirstName": "JON",
"AuthorizedOfficialMiddleName": "N",
"AuthorizedOfficialTitle": "CHIROPRACTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "631-345-3035",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "X4005-1",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}