{
"Npi": {
"NPI": "1881902591",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DR. KIM LEIS-KEELING, 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": "1770 SWITCHGRASS CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SHAKOPEE",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55379-8533",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "612-834-2779",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2121 CLIFF DR STE 101",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "EAGAN",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55122-3407",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "612-834-2779",
"PracticeLocationAddressFaxNumber": "654-330-3901",
"EnumerationDate": "09/15/2010",
"LastUpdateDate": "09/15/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LEIS-KEELING",
"AuthorizedOfficialFirstName": "KIM",
"AuthorizedOfficialMiddleName": "M.",
"AuthorizedOfficialTitle": "CHIROPRACTOR/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "612-834-2779",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111NS0005X",
"TaxonomyName": "Sports Physician Chiropractor",
"LicenseNumber": "4498",
"LicenseNumberStateCode": "MN",
"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."
}
}
}
}