Provider Demographics
NPI:1114031168
Name:ALBRECHT, DARL DEVON (DC)
Entity Type:Individual
Prefix:DR
First Name:DARL
Middle Name:DEVON
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 1:304 DIX STREET
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MI
Mailing Address - Zip Code:49078
Mailing Address - Country:US
Mailing Address - Phone:269-694-9956
Mailing Address - Fax:269-694-9400
Practice Address - Street 1:304 DIX STREET
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MI
Practice Address - Zip Code:49078
Practice Address - Country:US
Practice Address - Phone:269-694-9956
Practice Address - Fax:269-694-9400
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI005124111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95-0-Z3-5006-0OtherBLUE CROSS
MI0P52880Medicare UPIN
MI95-0-Z3-5006-0OtherBLUE CROSS