{
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"OrgName": "INDEPENDENCE CHIROPRACTIC, INC.",
"LastName": null,
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"FirstLineMailingAddress": "1922 WALTON NICHOOLSON ROAD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "INDEPENDENCE",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "41051",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "859-363-1000",
"MailingAddressFaxNumber": "859-363-0836",
"FirstLinePracticeLocationAddress": "1922 WALTON NICHOOLSON ROAD",
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"PracticeLocationAddressCityName": "INDEPENDENCE",
"PracticeLocationAddressStateName": "KY",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "859-363-1000",
"PracticeLocationAddressFaxNumber": "859-363-0836",
"EnumerationDate": "08/30/2012",
"LastUpdateDate": "08/28/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": "05/21/2013",
"NPIReactivationDate": "08/27/2013",
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SKINNER",
"AuthorizedOfficialFirstName": "DEAN",
"AuthorizedOfficialMiddleName": "D.",
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "859-363-1000",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "4327",
"LicenseNumberStateCode": "KY",
"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."
}
}
}
}