{
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"FirstLineMailingAddress": "4709 KINGS WAY N",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GURNEE",
"MailingAddressStateName": "IL",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "34121 N US HIGHWAY 45",
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"EnumerationDate": "01/23/2010",
"LastUpdateDate": "11/10/2011",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SENKPEIL",
"AuthorizedOfficialFirstName": "EDWARD",
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"AuthorizedOfficialCredential": "M.A.",
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"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}