{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "BACK TO HEALTH CHIROPRACTIC, INC.",
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "27450 YNEZ RD",
"SecondLineMailingAddress": "116",
"MailingAddressCityName": "TEMECULA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92591",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "951-587-2225",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "27450 YNEZ RD",
"SecondLinePracticeLocationAddress": "116",
"PracticeLocationAddressCityName": "TEMECULA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92591-4649",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "951-587-2225",
"PracticeLocationAddressFaxNumber": "951-587-2220",
"EnumerationDate": "10/17/2006",
"LastUpdateDate": "02/08/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BANASIAK",
"AuthorizedOfficialFirstName": "MARK",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DR OF CHIROPRACTIC",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "951-587-2225",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "DC23625",
"LicenseNumberStateCode": "CA",
"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."
}
}
}
}