Healthcare Provider Details

I. General information

NPI: 1639015076
Provider Name (Legal Business Name): SAYDI SUSANNE SULLIVAN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3013 N RANGE LINE RD
JOPLIN MO
64801-9753
US

IV. Provider business mailing address

710 S DREHER ST
WEIR KS
66781-4215
US

V. Phone/Fax

Practice location:
  • Phone: 417-782-0330
  • Fax:
Mailing address:
  • Phone: 620-210-1651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01-06442
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2026015996
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: