{
"Npi": {
"NPI": "1871819532",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ACTIVE LIFE SOLUTIONS, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "6671 W INDIANTOWN RD",
"SecondLineMailingAddress": "# 50-438",
"MailingAddressCityName": "JUPITER",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33458-3991",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "561-386-8311",
"MailingAddressFaxNumber": "561-748-8551",
"FirstLinePracticeLocationAddress": "850 W INDIANTOWN RD",
"SecondLinePracticeLocationAddress": "SUITE C",
"PracticeLocationAddressCityName": "JUPITER",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33458-7539",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "561-386-8311",
"PracticeLocationAddressFaxNumber": "561-748-8551",
"EnumerationDate": "04/20/2010",
"LastUpdateDate": "04/20/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LAINE",
"AuthorizedOfficialFirstName": "PAUL",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPT",
"AuthorizedOfficialTelephoneNumber": "561-758-8810",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QH0100X",
"TaxonomyName": "Health Service Clinic/Center",
"LicenseNumber": "ME0076092",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}