{
"Npi": {
"NPI": "1679055115",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ISOM CHIROPRACTIC LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "8145 RENNER RD APT 3",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LENEXA",
"MailingAddressStateName": "KS",
"MailingAddressPostalCode": "66219-8012",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "913-735-9565",
"MailingAddressFaxNumber": "913-273-0009",
"FirstLinePracticeLocationAddress": "10942 W 74TH TER",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SHAWNEE",
"PracticeLocationAddressStateName": "KS",
"PracticeLocationAddressPostalCode": "66203-4420",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "913-735-9565",
"PracticeLocationAddressFaxNumber": "913-273-0009",
"EnumerationDate": "08/31/2018",
"LastUpdateDate": "07/02/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ISOM",
"AuthorizedOfficialFirstName": "JOSHUA",
"AuthorizedOfficialMiddleName": "MICHAERL",
"AuthorizedOfficialTitle": "PROVIDER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "913-735-9565",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "01-05696",
"LicenseNumberStateCode": "KS",
"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."
}
}
}
}