{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "R.E. CHIROPRACTIC SERVICES, PLLC",
"LastName": null,
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"FirstLineMailingAddress": "6 JULIA CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MIDDLE ISLAND",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11953-2652",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "516-526-2793",
"MailingAddressFaxNumber": "718-709-5913",
"FirstLinePracticeLocationAddress": "139-39 35TH AVE.",
"SecondLinePracticeLocationAddress": "SUITE CFB",
"PracticeLocationAddressCityName": "FLUSHING",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "516-526-2793",
"PracticeLocationAddressFaxNumber": "718-709-5913",
"EnumerationDate": "03/10/2014",
"LastUpdateDate": "03/17/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "EBBRECHT",
"AuthorizedOfficialFirstName": "RICHARD",
"AuthorizedOfficialMiddleName": "FREDRICK",
"AuthorizedOfficialTitle": "BILLING MANAGER",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "MONICA KIM",
"AuthorizedOfficialTelephoneNumber": "646-732-2758",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "X010189-1",
"LicenseNumberStateCode": "NY",
"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."
}
}
}
}