{
"Npi": {
"NPI": "1871056382",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "SERRANO",
"FirstName": "JACQUELINE",
"MiddleName": "EVAMARIE",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "VEKICH",
"OtherFirstName": "JACQUELINE",
"OtherMiddleName": "EVAMARIE",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "DC",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "102 VIA PESEDA",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN CLEMENTE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92673",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "619-995-5922",
"MailingAddressFaxNumber": "949-627-8110",
"FirstLinePracticeLocationAddress": "28062 FORBES ROAD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAGUNA NIGUEL",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92677",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "949-345-1160",
"PracticeLocationAddressFaxNumber": "949-627-8110",
"EnumerationDate": "04/11/2019",
"LastUpdateDate": "07/26/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "34480",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "DC34480",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}