{
"Npi": {
"NPI": "1801097746",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "RESTAD CHIROPRACTIC PLLC",
"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": "1660 LOCH NESS AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MIDDLETON",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83644-7109",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "707-774-5232",
"MailingAddressFaxNumber": "707-773-2224",
"FirstLinePracticeLocationAddress": "1012 W MAIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MIDDLETON",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83644-5270",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "707-774-5232",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/29/2007",
"LastUpdateDate": "01/12/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RESTAD",
"AuthorizedOfficialFirstName": "JULIE",
"AuthorizedOfficialMiddleName": "LEE",
"AuthorizedOfficialTitle": "OWNER/CHIROPRACTOR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "707-774-5232",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "DC29715",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
}
}
}