{
"Npi": {
"NPI": "1770974602",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TOWN AND COUNTRY CHIROPRACTIC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "255 N MAIN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MADISON",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30650-1390",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "706-438-1314",
"MailingAddressFaxNumber": "706-438-1315",
"FirstLinePracticeLocationAddress": "255 N MAIN ST STE C",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MADISON",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30650-1390",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "706-438-1314",
"PracticeLocationAddressFaxNumber": "706-438-1315",
"EnumerationDate": "02/13/2015",
"LastUpdateDate": "12/28/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PIZZA",
"AuthorizedOfficialFirstName": "VANESSA",
"AuthorizedOfficialMiddleName": "N",
"AuthorizedOfficialTitle": "OWNER/DOCTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "706-438-1314",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "CHIR009323",
"LicenseNumberStateCode": "GA",
"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."
}
}
}
}