{
"Npi": {
"NPI": "1982930749",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ALLEN CHIROPRACTIC WELLNESS CENTER",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1018 S WESTWOOD BLVD",
"SecondLineMailingAddress": "SUITE 5",
"MailingAddressCityName": "POPLAR BLUFF",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "63901-6108",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "573-778-0500",
"MailingAddressFaxNumber": "573-778-0160",
"FirstLinePracticeLocationAddress": "1018 S WESTWOOD BLVD",
"SecondLinePracticeLocationAddress": "SUITE 5",
"PracticeLocationAddressCityName": "POPLAR BLUFF",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "63901-6108",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "573-778-0500",
"PracticeLocationAddressFaxNumber": "573-778-0160",
"EnumerationDate": "10/28/2009",
"LastUpdateDate": "10/28/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ALLEN",
"AuthorizedOfficialFirstName": "LAURIE",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C., F.I.A.M.A.",
"AuthorizedOfficialTelephoneNumber": "573-778-0500",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QH0100X",
"TaxonomyName": "Health Service Clinic/Center",
"LicenseNumber": "CE 6097",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}