Individual
DR. NICOLE LEIGH SDAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
455 W STEPHENSON ST, FREEPORT, IL 61032-5001
(815) 232-4217
(815) 233-3379
Mailing address
455 W STEPHENSON ST, FREEPORT, IL 61032-5001
(815) 232-4217
Taxonomy
Speciality
Code
Description
License number
State
111NX0800X
Orthopedic Chiropractor
Primary
038-008743
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
038-008743
—
IL
01
—
08925958
BLUE CROSS BLUE SHEILD #
IL
01
—
350049409
MEDICARE RAILROAD #
IL
01
—
36-3581491
ICHP TAX I.D. #
IL
01
—
75-3157454
PRACTICE CORP. TAX I.D.#
IL
01
—
K13271
MEDICARE MEMBER #
IL
Enumeration date
07/28/2006
Last updated
12/06/2013
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