Healthcare Provider Details

I. General information

NPI: 1457630063
Provider Name (Legal Business Name): TYLER DARL ALBRECHT D.C., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2011
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 TREE BLVD STE 8
ST AUGUSTINE FL
32084-5719
US

IV. Provider business mailing address

1750 TREE BLVD STE 8
ST AUGUSTINE FL
32084-5719
US

V. Phone/Fax

Practice location:
  • Phone: 904-429-7750
  • Fax: 904-429-7664
Mailing address:
  • Phone: 904-429-7750
  • Fax: 904-429-7664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH9751
License Number StateFL

VIII. Authorized Official

Name: DR. TYLER DARL ALBRECHT
Title or Position: OWNER
Credential: D.C.
Phone: 904-429-7750