Provider Demographics
NPI:1669721692
Name:HOLLABAUGH, JASON A (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:A
Last Name:HOLLABAUGH
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 1:7098 LOCKWOOD BLVD STE 7106
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4064
Mailing Address - Country:US
Mailing Address - Phone:330-507-5533
Mailing Address - Fax:
Practice Address - Street 1:7098 LOCKWOOD BLVD STE 7106
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4064
Practice Address - Country:US
Practice Address - Phone:330-953-1858
Practice Address - Fax:330-954-0789
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAJ010434111N00000X
PADC010641111N00000X
OH4296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0098380Medicaid
OH46-2558163OtherTAX ID/EIN
OH46-2558163OtherTAX ID/EIN