{
"Npi": {
"NPI": "1902341548",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BLOSSOM CHIROPRACTIC AND NATURAL MEDICINE",
"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": "6106 115TH AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KENOSHA",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53142-7274",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "262-220-8500",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3601 30TH AVE",
"SecondLinePracticeLocationAddress": "SUITE 101",
"PracticeLocationAddressCityName": "KENOSHA",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "53144-1695",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "262-220-8500",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/05/2017",
"LastUpdateDate": "01/05/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CASHMORE",
"AuthorizedOfficialFirstName": "OLIVIA",
"AuthorizedOfficialMiddleName": "BRESSY",
"AuthorizedOfficialTitle": "PRESIDENT/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C., C.C.N",
"AuthorizedOfficialTelephoneNumber": "262-220-8500",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "111NN1001X",
"TaxonomyName": "Nutrition Chiropractor",
"LicenseNumber": "038010095",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "111NP0017X",
"TaxonomyName": "Pediatric Chiropractor",
"LicenseNumber": "5085",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "111NP0017X",
"TaxonomyName": "Pediatric Chiropractor",
"LicenseNumber": "038010095",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "111NR0400X",
"TaxonomyName": "Rehabilitation Chiropractor",
"LicenseNumber": "5085",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "111NR0400X",
"TaxonomyName": "Rehabilitation Chiropractor",
"LicenseNumber": "038010095",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "111NN1001X",
"TaxonomyName": "Nutrition Chiropractor",
"LicenseNumber": "5085",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}