{
"Npi": {
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"ReplacementNPI": null,
"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FULL LIFE CHIROPRACTIC, PA",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2300 W EVEREST LN",
"SecondLineMailingAddress": "SUITE #175",
"MailingAddressCityName": "MERIDIAN",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83646-5925",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-895-0858",
"MailingAddressFaxNumber": "208-895-0561",
"FirstLinePracticeLocationAddress": "2300 W EVEREST LN",
"SecondLinePracticeLocationAddress": "SUITE #175",
"PracticeLocationAddressCityName": "MERIDIAN",
"PracticeLocationAddressStateName": "ID",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-895-0858",
"PracticeLocationAddressFaxNumber": "208-895-0561",
"EnumerationDate": "08/13/2007",
"LastUpdateDate": "12/20/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MAIN",
"AuthorizedOfficialFirstName": "JONATHAN",
"AuthorizedOfficialMiddleName": "ERIC",
"AuthorizedOfficialTitle": "OWNER / PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "208-895-0858",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "C9495",
"LicenseNumberStateCode": "ID",
"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."
}
}
}
}