Provider Demographics
NPI:1821183740
Name:SAWAYA, ALBERT PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:PETER
Last Name:SAWAYA
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 1:120 COMMERCE CT
Mailing Address - Street 2:
Mailing Address - City:GLADWIN
Mailing Address - State:MI
Mailing Address - Zip Code:48624-1220
Mailing Address - Country:US
Mailing Address - Phone:989-426-6121
Mailing Address - Fax:989-426-5466
Practice Address - Street 1:120 COMMERCE CT
Practice Address - Street 2:
Practice Address - City:GLADWIN
Practice Address - State:MI
Practice Address - Zip Code:48624-1220
Practice Address - Country:US
Practice Address - Phone:989-426-6121
Practice Address - Fax:989-426-5466
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005236111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1814784Medicaid
MI950B610080OtherBLUE CROSS BLUE SHIELD ID
MI1814784Medicaid