Healthcare Provider Details

I. General information

NPI: 1881130078
Provider Name (Legal Business Name): NICHOLAS DEFLUMERI DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2017
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BALTIMORE PL NW SUITE 100
ATLANTA GA
30308-2116
US

IV. Provider business mailing address

230 18TH ST NW UNIT 11204
ATLANTA GA
30363-1073
US

V. Phone/Fax

Practice location:
  • Phone: 678-331-4500
  • Fax:
Mailing address:
  • Phone: 678-331-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberCHIR009534
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: