Healthcare Provider Details

I. General information

NPI: 1679975924
Provider Name (Legal Business Name): JASON A HOLLABAUGH,DC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7098 LOCKWOOD BLVD STE 7106
YOUNGSTOWN OH
44512-4064
US

IV. Provider business mailing address

7098 LOCKWOOD BLVD STE 7106
YOUNGSTOWN OH
44512-4064
US

V. Phone/Fax

Practice location:
  • Phone: 330-953-1858
  • Fax: 330-954-0789
Mailing address:
  • Phone: 330-953-1858
  • Fax: 330-954-0789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JASON A HOLLABAUGH
Title or Position: OWNER
Credential:
Phone: 330-953-1858