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General NPI Number Information
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NPI Number | 1780866525
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Entity Type | Organization
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Legal Business Name | WOODVILLE PROFESSIONAL HEALTHCARE LLC
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 10/18/2021
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Provider Practice Location Address
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Address Line | 444 N STONE ST
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City | FREMONT
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State | OH
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Zip | 43420-1530
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Country | US
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Telephone | 419-334-7737
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Fax | 419-334-2828
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Provider Business Mailing Address
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Address Line | 444 N STONE ST
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City | FREMONT
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State | OH
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Zip | 43420-1530
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Country | US
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Telephone | 419-334-7737
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Fax | 419-334-2828
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Authorized Official
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Title or Position | OWNER
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Name | DR. TY N TRACY
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Credential | DC
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Telephone | 419-334-7737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2805
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License Number State | OH
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