# WOODVILLE PROFESSIONAL HEALTHCARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Fremont Chiropractic Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780866525
- **Authorized official:** DR. TY N TRACY DC (OWNER)
- **Authorized official phone:** (419) 334-7737

## Contact information

- **Practice address:** 444 N STONE ST, FREMONT, OH 43420-1530
- **Practice address phone:** (419) 334-7737
- **Practice address fax:** (419) 334-2828
- **Mailing address:** 444 N STONE ST, FREMONT, OH 43420-1530
- **Mailing address phone:** (419) 334-7737
- **Mailing address fax:** (419) 334-2828

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | 2805 | OH | Yes |

## Other

- **Enumeration date:** 12/04/2007
- **Last updated:** 10/18/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000362532 | ANTHEM BCBS | OH |