{
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"NPI": "1922293711",
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"ReplacementNPI": null,
"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "DORN FAMILY CHIROPRACTIC LLC",
"LastName": null,
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"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "W359N5002 BROWN ST STE 220A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OCONOMOWOC",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53066-3366",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "262-203-9036",
"MailingAddressFaxNumber": "262-203-9774",
"FirstLinePracticeLocationAddress": "W359N5002 BROWN ST STE 220A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OCONOMOWOC",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "53066-3366",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "262-203-9036",
"PracticeLocationAddressFaxNumber": "262-203-9774",
"EnumerationDate": "09/13/2007",
"LastUpdateDate": "01/06/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DORN",
"AuthorizedOfficialFirstName": "ROBY",
"AuthorizedOfficialMiddleName": "C",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "262-203-9036",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "4053-012",
"LicenseNumberStateCode": "WI",
"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."
}
}
}
}