Provider Demographics
NPI:1891760732
Name:NOOROLLAH, JAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:JAVID
Middle Name:
Last Name:NOOROLLAH
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 1:9617 BENSON ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-4033
Mailing Address - Country:US
Mailing Address - Phone:913-642-3397
Mailing Address - Fax:
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:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04907111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS000D605Medicare ID - Type Unspecified