{
"Npi": {
"NPI": "1760505531",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ZACHARY ZANE LESLIE DC PA",
"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": "100 WILLOW CREEK PARKWAY",
"SecondLineMailingAddress": "SUITE B",
"MailingAddressCityName": "PALESTINE",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75801",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "903-729-5051",
"MailingAddressFaxNumber": "903-729-0316",
"FirstLinePracticeLocationAddress": "100 WILLOW CREEK PARKWAY",
"SecondLinePracticeLocationAddress": "SUITE B",
"PracticeLocationAddressCityName": "PALESTINE",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75801",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "903-729-5051",
"PracticeLocationAddressFaxNumber": "903-729-0316",
"EnumerationDate": "04/09/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LESLIE",
"AuthorizedOfficialFirstName": "ZACHARY",
"AuthorizedOfficialMiddleName": "ZANE",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "903-729-5051",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "10275",
"LicenseNumberStateCode": "TX",
"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."
}
}
}
}