{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ELEVATE CHIROPRACTIC, JIMMY SAYEGH CHIROPRACTIC CORP.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherNamePrefix": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "10165 FOOTHILL BLVD",
"SecondLineMailingAddress": "SUITE 3",
"MailingAddressCityName": "RANCHO CUCAMONGA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91730-0340",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "909-989-6980",
"MailingAddressFaxNumber": "909-927-8262",
"FirstLinePracticeLocationAddress": "10165 FOOTHILL BLVD",
"SecondLinePracticeLocationAddress": "SUITE 3",
"PracticeLocationAddressCityName": "RANCHO CUCAMONGA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91730-0340",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "909-989-6980",
"PracticeLocationAddressFaxNumber": "909-927-8262",
"EnumerationDate": "09/25/2013",
"LastUpdateDate": "10/07/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SAYEGH",
"AuthorizedOfficialFirstName": "JIMMY",
"AuthorizedOfficialMiddleName": "RIMON",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "909-989-6980",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "32515",
"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."
}
}
}
}