{
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"FirstLineMailingAddress": "18328 BUCCANEER TER",
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"MailingAddressTelephoneNumber": "703-481-4400",
"MailingAddressFaxNumber": "703-935-0430",
"FirstLinePracticeLocationAddress": "19945 RIVERSIDE COMMONS PLZ STE 100",
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"EnumerationDate": "02/10/2012",
"LastUpdateDate": "11/12/2025",
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"GenderCode": null,
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"AuthorizedOfficialLastName": "SHORT",
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"AuthorizedOfficialCredential": "DC",
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"Taxonomies": {
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"TaxonomyName": "Sports Physician Chiropractor",
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"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
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}
}
}
}