{
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"IsOrgSubpart": "N",
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"OrgName": "PROFICIENT CHIROPRACTIC HOLDINGS LLC",
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "10251 LINCOLN TRL",
"SecondLineMailingAddress": "SUITE 4",
"MailingAddressCityName": "FAIRVIEW HEIGHTS",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "62208-1846",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "314-276-4154",
"MailingAddressFaxNumber": "314-447-0726",
"FirstLinePracticeLocationAddress": "2050 WOODSON RD",
"SecondLinePracticeLocationAddress": "SUITE 101",
"PracticeLocationAddressCityName": "SAINT LOUIS",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "63114-5644",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "314-276-4154",
"PracticeLocationAddressFaxNumber": "314-447-0726",
"EnumerationDate": "12/12/2013",
"LastUpdateDate": "12/12/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "EVERETT",
"AuthorizedOfficialFirstName": "EDGAR",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": "III",
"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "314-276-4154",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": null,
"LicenseNumberStateCode": "MO",
"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."
}
}
}
}