Provider Demographics
NPI:1801534946
Name:SIVO, PAUL RYAN JR
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:RYAN
Last Name:SIVO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 NE TUDOR RD APT 6
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5784
Mailing Address - Country:US
Mailing Address - Phone:401-829-3758
Mailing Address - Fax:
Practice Address - Street 1:203 S MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:GRAIN VALLEY
Practice Address - State:MO
Practice Address - Zip Code:64029-9703
Practice Address - Country:US
Practice Address - Phone:816-443-5485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022017324111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor