Provider Demographics
NPI:1487356259
Name:OVERHOLSER, CALEB
Entity type:Individual
Prefix:DR
First Name:CALEB
Middle Name:
Last Name:OVERHOLSER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-2261
Mailing Address - Country:US
Mailing Address - Phone:570-650-3797
Mailing Address - Fax:
Practice Address - Street 1:916 COLUMBUS AVE STE 4A
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-2883
Practice Address - Country:US
Practice Address - Phone:563-396-9539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-05246111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician