Provider Demographics
NPI:1770500225
Name:FREY, TIMOTHY MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:FREY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 INDEPENDENCE DRIVE
Mailing Address - Street 2:
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545
Mailing Address - Country:US
Mailing Address - Phone:419-592-7966
Mailing Address - Fax:419-599-0635
Practice Address - Street 1:390 INDEPENDENCE DRIVE
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545
Practice Address - Country:US
Practice Address - Phone:419-592-7966
Practice Address - Fax:419-599-0635
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH804111N00000X
MI6093111N00000X
GA6520111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000132345OtherANTHEM BCBS
OH34146624100OtherWORKERS COMPENSATION
OH5627090OtherAETNA
OH0426980Medicaid
OHFR0476003Medicare ID - Type Unspecified
OH34146624100OtherWORKERS COMPENSATION