MEDICARE: DR. TRACY A HOMAN DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	5162	KY
2	111N00000X	Chiropractor	03544	OH

General Provider Information

NPI Number	:	1043254279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACY A HOMAN DC

Provider Business Mailing Address
First Line	:	4380 GLENESTE WITHAMSVILLE RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45245-1523
Country	:	US
Telephone Number	:	513-753-6325
Fax Number	:	513-753-6320

Provider Business Practice Location Address
First Line	:	4380 GLENESTE WITHAMSVILLE RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45245-1523
Country	:	US
Telephone Number	:	513-753-6325
Fax Number	:	513-753-6320

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	11/10/2021

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