Healthcare Provider Details

I. General information

NPI: 1982937173
Provider Name (Legal Business Name): TYLER DARL ALBRECHT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2009
Last Update Date: 12/21/2011
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:
Title or Position:
Credential:
Phone: