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General NPI Number Information
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NPI Number | 1073446076
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Entity Type | Individual
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Provider Name | JAYCOB M. HOLOHAN DC
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Gender | Male
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Dates
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Enumeration Date | 06/08/2026
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Last Update Date | 06/08/2026
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Provider Practice Location Address
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Address Line | 1001 SW WILSHIRE BLVD STE D
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City | BURLESON
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State | TX
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Zip | 76028-5716
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Country | US
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Telephone | 817-447-1414
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Fax | 817-447-3463
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Provider Business Mailing Address
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Address Line | 617 KENTUCKY DERBY LN
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City | FORT WORTH
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State | TX
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Zip | 76179-7315
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Country | US
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Telephone | 817-876-8763
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 16698
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License Number State | TX
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