{
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"NamePrefix": null,
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"FirstLineMailingAddress": "PO BOX 248",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "VINITA",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "74301-0248",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "918-256-5111",
"MailingAddressFaxNumber": "918-256-5222",
"FirstLinePracticeLocationAddress": "803 N FOREMAN ST",
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"PracticeLocationAddressCityName": "VINITA",
"PracticeLocationAddressStateName": "OK",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "918-256-5111",
"PracticeLocationAddressFaxNumber": "918-256-5222",
"EnumerationDate": "10/25/2011",
"LastUpdateDate": "08/27/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CLARK",
"AuthorizedOfficialFirstName": "JOSEPH",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "918-256-5111",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "4016",
"LicenseNumberStateCode": "OK",
"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."
}
}
}
}