{
"Npi": {
"NPI": "1811205073",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WESLEY CAVANAUGH DC, LLC",
"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": "317 W SOUTH BOULDER RD",
"SecondLineMailingAddress": "SUITE 2",
"MailingAddressCityName": "LOUISVILLE",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80027-1289",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "303-604-6040",
"MailingAddressFaxNumber": "303-313-0994",
"FirstLinePracticeLocationAddress": "317 W SOUTH BOULDER RD",
"SecondLinePracticeLocationAddress": "SUITE 2",
"PracticeLocationAddressCityName": "LOUISVILLE",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80027-1289",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "303-604-6040",
"PracticeLocationAddressFaxNumber": "303-313-0994",
"EnumerationDate": "09/21/2010",
"LastUpdateDate": "09/21/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CAVANAUGH",
"AuthorizedOfficialFirstName": "WESLEY",
"AuthorizedOfficialMiddleName": "MICHAEL",
"AuthorizedOfficialTitle": "OWNER/MEMBER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "303-604-6040",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "6428",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}