{
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"EIN": null,
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"FirstLineMailingAddress": "124 MAINE ST STE 215",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BRUNSWICK",
"MailingAddressStateName": "ME",
"MailingAddressPostalCode": "04011-2078",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "207-729-4645",
"MailingAddressFaxNumber": "207-721-1189",
"FirstLinePracticeLocationAddress": "124 MAINE ST STE 215",
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"PracticeLocationAddressCityName": "BRUNSWICK",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "207-729-4645",
"PracticeLocationAddressFaxNumber": "207-721-1189",
"EnumerationDate": "05/02/2016",
"LastUpdateDate": "05/02/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STEINHOUSER",
"AuthorizedOfficialFirstName": "JASON",
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"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "207-729-4645",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "CR1356",
"LicenseNumberStateCode": "ME",
"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."
}
}
}
}