Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC 5209 | TX |
NPI | 1003839929 |
---|---|
Provider Name | Dr. Nick G. Albracht |
First Address | Burleson, TX 76028-4574 |
Second Address | Burleson, TX 76028-4574 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
605883 | BCBS PROVIDER # (01) | TX |
U72496 | (02) | TX |