Healthcare Provider Details

I. General information

NPI: 1568631505
Provider Name (Legal Business Name): JAKE OVERHOLT DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 06/16/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 UPPER GILCHRIST RD
MT VERNON OH
43050
US

IV. Provider business mailing address

11301 UPPER GILCHRIST RD
MT VERNON OH
43050
US

V. Phone/Fax

Practice location:
  • Phone: 740-392-1407
  • Fax: 740-392-0334
Mailing address:
  • Phone: 740-392-1407
  • Fax: 740-392-0334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3887
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: