Healthcare Provider Details

I. General information

NPI: 1770500225
Provider Name (Legal Business Name): TIMOTHY MICHAEL FREY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 INDEPENDENCE DRIVE
NAPOLEON OH
43545
US

IV. Provider business mailing address

390 INDEPENDENCE DRIVE
NAPOLEON OH
43545
US

V. Phone/Fax

Practice location:
  • Phone: 419-592-7966
  • Fax: 419-599-0635
Mailing address:
  • Phone: 419-592-7966
  • Fax: 419-599-0635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number804
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6093
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6520
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: