=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104776095
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORAL CHIROPRACTIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2026
-----------------------------------------------------
Last Update Date | 01/30/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17795 W 106TH ST STE 200
-----------------------------------------------------
City | OLATHE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66061-3155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-355-5164
-----------------------------------------------------
Fax | 913-276-1339
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17795 W 106TH ST STE 200
-----------------------------------------------------
City | OLATHE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66061-3155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-355-5164
-----------------------------------------------------
Fax | 913-276-1339
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | MARJAN SADEGHI
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 913-355-5164
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------