Healthcare Provider Details

I. General information

NPI: 1538497961
Provider Name (Legal Business Name): 1ST CHOICE HEALTH & WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2009
Last Update Date: 11/23/2009
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

2441 STATE ST STE 10
NEW ALBANY IN
47150-4962
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 Code225100000X
TaxonomyPhysical Therapist
License Number05005346A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001189A
License Number StateIN

VIII. Authorized Official

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