{
"Npi": {
"NPI": "1699913970",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BACK TO WELLNESS CHIROPRACTIC",
"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": "1173 7TH ST W",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAINT PAUL",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55102-3915",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "952-693-1565",
"MailingAddressFaxNumber": "651-925-0073",
"FirstLinePracticeLocationAddress": "1173 7TH ST W",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAINT PAUL",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55102-3915",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "952-693-1565",
"PracticeLocationAddressFaxNumber": "651-925-0073",
"EnumerationDate": "01/26/2009",
"LastUpdateDate": "03/14/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ORR",
"AuthorizedOfficialFirstName": "KAYLA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CHIROPRACTOR/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "952-693-3736",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "5073",
"LicenseNumberStateCode": "MN",
"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."
}
}
}
}