Healthcare Provider Details

I. General information

NPI: 1699892299
Provider Name (Legal Business Name): 1ST CHOICE MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2441 STATE ST STE 10
NEW ALBANY IN
47150-4962
US

IV. Provider business mailing address

PO BOX 1241
NEW ALBANY IN
47151-1241
US

V. Phone/Fax

Practice location:
  • Phone: 812-945-4500
  • Fax: 812-945-4808
Mailing address:
  • Phone: 812-945-4500
  • Fax: 812-945-4808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number01046210A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05005346A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001189A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002214A
License Number StateIN

VIII. Authorized Official

Name: LANE CHRISTOPHER NUNIER
Title or Position: PRESIDENT
Credential: DC
Phone: 812-945-4500