{
"Npi": {
"NPI": "1710671334",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NEUROPAIN AND WELLNESS, LLC",
"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": "8480 W STATE ROAD 84",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DAVIE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33324-4533",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "954-577-0177",
"MailingAddressFaxNumber": "954-577-0175",
"FirstLinePracticeLocationAddress": "1403 W BOYNTON BEACH BLVD STE 13",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BOYNTON BEACH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33426-3463",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "561-374-7437",
"PracticeLocationAddressFaxNumber": "561-364-7414",
"EnumerationDate": "06/06/2023",
"LastUpdateDate": "06/08/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HORNING",
"AuthorizedOfficialFirstName": "DREW",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OFFICE MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "954-577-0177",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208VP0000X",
"TaxonomyName": "Pain Medicine Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}