Healthcare Provider Details

I. General information

NPI: 1508708561
Provider Name (Legal Business Name): MANGUS CHIROPRACTIC & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8604 E 63RD ST
KANSAS CITY MO
64133-4725
US

IV. Provider business mailing address

110 S CHESTNUT ST APT 1510
OLATHE KS
66061-3505
US

V. Phone/Fax

Practice location:
  • Phone: 913-308-0403
  • Fax:
Mailing address:
  • Phone: 402-920-2325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: COLT MANGUS
Title or Position: OWNER
Credential: MANGUS
Phone: 402-920-2325