Individual
DR. ROGER SDAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
455 W. STEPHENSON ST., FREEPORT, IL 61032
(815) 232-4217
(815) 233-3379
Mailing address
455 W. STEPHENSON ST., FREEPORT, IL 61032
(815) 297-1807
Taxonomy
Speciality
Code
Description
License number
State
111NX0800X
Orthopedic Chiropractor
Primary
038-009058
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08925958
BLUE CROSS BLUE SHIELD #
IL
01
—
350049409
MEDICARE RAILROAD
IL
01
—
K13270
MEDICARE MEMBER #
IL
Enumeration date
07/26/2006
Last updated
12/30/2016
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