{
"Npi": {
"NPI": "1699102400",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "M. GEOFFREYS, A PROFESSIONAL CHIROPRACTIC CORPORATION",
"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": "24863 DEL PRADO",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DANA POINT",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92629",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "949-248-1314",
"MailingAddressFaxNumber": "949-248-1335",
"FirstLinePracticeLocationAddress": "24863 DEL PRADO",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DANA POINT",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92629-2853",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "949-248-1314",
"PracticeLocationAddressFaxNumber": "949-248-1335",
"EnumerationDate": "10/11/2013",
"LastUpdateDate": "03/05/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GEOFFREYS",
"AuthorizedOfficialFirstName": "MARTIN",
"AuthorizedOfficialMiddleName": "D.",
"AuthorizedOfficialTitle": "OWNER/CHIROPRACTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C., CCSP",
"AuthorizedOfficialTelephoneNumber": "949-248-1314",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111NS0005X",
"TaxonomyName": "Sports Physician Chiropractor",
"LicenseNumber": "23040",
"LicenseNumberStateCode": "CA",
"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."
}
}
}
}