{
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"IsOrgSubpart": "N",
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"NamePrefix": null,
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"FirstLineMailingAddress": "4103 W POTOMAC AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHICAGO",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60651-1853",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "773-486-9546",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3354 N PAULINA ST",
"SecondLinePracticeLocationAddress": "SUITE 206C",
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"PracticeLocationAddressTelephoneNumber": "773-991-5131",
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"EnumerationDate": "05/23/2008",
"LastUpdateDate": "05/23/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HORIGAN",
"AuthorizedOfficialFirstName": "GREGG",
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"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "773-991-5131",
"Taxonomies": {
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"TaxonomyName": "Clinic/Center",
"LicenseNumber": "038-006984",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}