{
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"FirstLineMailingAddress": "1270 S ALFRED ST # 1064",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "1425 W MANCHESTER AVE UNIT A1425",
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"EnumerationDate": "02/28/2025",
"LastUpdateDate": "02/28/2025",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DAVIDSON",
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"AuthorizedOfficialCredential": "MD PHD DBA ND",
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"Taxonomies": {
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}
}
}