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General NPI Number Information
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NPI Number | 1699799346
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Entity Type | Individual
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Provider Name | ROGER SDAO D.C.
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Gender | Male
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 12/30/2016
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Provider Practice Location Address
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Address Line | 455 W. STEPHENSON ST.
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City | FREEPORT
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State | IL
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Zip | 61032
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Country | US
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Telephone | 815-232-4217
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Fax | 815-233-3379
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Provider Business Mailing Address
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Address Line | 455 W. STEPHENSON ST.
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City | FREEPORT
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State | IL
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Zip | 61032
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Country | US
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Telephone | 815-297-1807
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | 038-009058
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License Number State | IL
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