MEDICARE: TREVOR OVERBAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	12465	AR

General Provider Information

NPI Number	:	1457210205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TREVOR OVERBAY

Provider Business Mailing Address
First Line	:	835 S DONAGHEY AVE APT 1626
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72034-7055
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12911 CANTRELL RD STE 4
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72223-1710
Country	:	US
Telephone Number	:	501-224-1224
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2026
Last Update Date	:	01/19/2026

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Directions to “ TREVOR OVERBAY ” Practice Location

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