Provider Demographics
NPI:1568631505
Name:OVERHOLT, JAKE (DC)
Entity Type:Individual
Prefix:
First Name:JAKE
Middle Name:
Last Name:OVERHOLT
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 1:11 WOODLAKE TRL STE B
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-8113
Mailing Address - Country:US
Mailing Address - Phone:740-392-1407
Mailing Address - Fax:740-392-0334
Practice Address - Street 1:11 WOODLAKE TRL STE B
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-8113
Practice Address - Country:US
Practice Address - Phone:740-392-1407
Practice Address - Fax:740-392-0334
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3887111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor