Provider Demographics
NPI:1801208921
Name:1ST CHOICE SPORTS REHABILITATION CENTER
Entity Type:Organization
Organization Name:1ST CHOICE SPORTS REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIKLAUS
Authorized Official - Middle Name:
Authorized Official - Last Name:DELFAVERO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-377-0011
Mailing Address - Street 1:2545 LAWRENCEVILLE HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3241
Mailing Address - Country:US
Mailing Address - Phone:404-377-0011
Mailing Address - Fax:
Practice Address - Street 1:2545 LAWRENCEVILLE HWY STE 100
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3241
Practice Address - Country:US
Practice Address - Phone:404-377-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-22
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty