=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639015076
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAYDI SUSANNE SULLIVAN DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2026
-----------------------------------------------------
Last Update Date | 04/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3013 N RANGE LINE RD
-----------------------------------------------------
City | JOPLIN
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64801-9753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-782-0330
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 710 S DREHER ST
-----------------------------------------------------
City | WEIR
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66781-4215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-210-1651
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 01-06442
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2026015996
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------