Provider Demographics
NPI:1255476719
Name:PROACTIVE CHIROPRACTIC, PA
Entity Type:Organization
Organization Name:PROACTIVE CHIROPRACTIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NOOROLLAH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-491-1500
Mailing Address - Street 1:6700 W 121ST ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2027
Mailing Address - Country:US
Mailing Address - Phone:913-491-1500
Mailing Address - Fax:913-469-0923
Practice Address - Street 1:6700 W 121ST ST
Practice Address - Street 2:SUITE 200
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2027
Practice Address - Country:US
Practice Address - Phone:913-491-1500
Practice Address - Fax:913-469-0923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4907111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty