{
"Npi": {
"NPI": "1780703397",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KENNETH T. MACK, P.A.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1525 S ALAFAYA TRL",
"SecondLineMailingAddress": "SUITE 105",
"MailingAddressCityName": "ORLANDO",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32828-8926",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "407-282-3223",
"MailingAddressFaxNumber": "407-282-3339",
"FirstLinePracticeLocationAddress": "1525 S ALAFAYA TRL",
"SecondLinePracticeLocationAddress": "SUITE 105",
"PracticeLocationAddressCityName": "ORLANDO",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32828-8926",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "407-282-3223",
"PracticeLocationAddressFaxNumber": "407-282-3339",
"EnumerationDate": "03/28/2007",
"LastUpdateDate": "06/26/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MACK",
"AuthorizedOfficialFirstName": "KENNETH",
"AuthorizedOfficialMiddleName": "THOMAS",
"AuthorizedOfficialTitle": "DOCTOR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C",
"AuthorizedOfficialTelephoneNumber": "407-282-3223",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "CH8704",
"LicenseNumberStateCode": "FL",
"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."
}
}
}
}