{
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"FirstLineMailingAddress": "4535 E LARCH AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GLENVIEW",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60025-1454",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "847-208-6594",
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"FirstLinePracticeLocationAddress": "4045 N DAMEN AVE STE 1",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHICAGO",
"PracticeLocationAddressStateName": "IL",
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"PracticeLocationAddressTelephoneNumber": "773-296-2766",
"PracticeLocationAddressFaxNumber": "773-296-2768",
"EnumerationDate": "03/29/2018",
"LastUpdateDate": "03/29/2018",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PARK",
"AuthorizedOfficialFirstName": "ANDY",
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"AuthorizedOfficialCredential": "DC",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Chiropractor",
"LicenseNumber": "038.013059",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}