{
"Npi": {
"NPI": "1952768756",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TOTAL BODY CHIROPRACTIC PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "10232 SHELBYVILLE RD",
"SecondLineMailingAddress": "SUITE 1A",
"MailingAddressCityName": "LOUISVILLE",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "40223-2978",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "502-785-4641",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "10232 SHELBYVILLE RD",
"SecondLinePracticeLocationAddress": "SUITE 1A",
"PracticeLocationAddressCityName": "LOUISVILLE",
"PracticeLocationAddressStateName": "KY",
"PracticeLocationAddressPostalCode": "40223-2978",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "502-785-4641",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/25/2016",
"LastUpdateDate": "07/26/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PORTER",
"AuthorizedOfficialFirstName": "JILLIAN",
"AuthorizedOfficialMiddleName": "R",
"AuthorizedOfficialTitle": "DOCTOR OF CHIROPRACTIC",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "812-431-5252",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QH0100X",
"TaxonomyName": "Health Service Clinic/Center",
"LicenseNumber": "5475",
"LicenseNumberStateCode": "KY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}