{
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"IsOrgSubpart": "N",
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"OrgName": "INDIAN TRAIL CHIROPRACTIC & REHABILITATION, PA",
"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "PO BOX 812",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "INDIAN TRAIL",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28079-0812",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "704-821-3222",
"MailingAddressFaxNumber": "704-821-3290",
"FirstLinePracticeLocationAddress": "100 PARK ROAD EAST",
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"PracticeLocationAddressCityName": "INDIAN TRAIL",
"PracticeLocationAddressStateName": "NC",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "704-821-3222",
"PracticeLocationAddressFaxNumber": "704-821-3290",
"EnumerationDate": "04/06/2009",
"LastUpdateDate": "04/06/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "EVEC",
"AuthorizedOfficialFirstName": "ANDREW",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "704-821-3222",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "2732",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X 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."
}
}
}
}