Provider Demographics
NPI:1982937173
Name:ALBRECHT, TYLER DARL (DC)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:DARL
Last Name:ALBRECHT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 TREE BLVD STE 8
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-5719
Mailing Address - Country:US
Mailing Address - Phone:904-429-7750
Mailing Address - Fax:904-429-7664
Practice Address - Street 1:1750 TREE BLVD STE 8
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-5719
Practice Address - Country:US
Practice Address - Phone:904-429-7750
Practice Address - Fax:904-429-7664
Is Sole Proprietor?:No
Enumeration Date:2009-09-07
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9751111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2209NOtherBLUE CROSS BLUE SHIELD OF FLORIDA
FLFK580ZMedicare PIN