Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | IL |
NPI | 1295809713 |
---|---|
Provider Name | Dr. Sean D Royer |
First Address | Highland Park, IL 60035-3200 |
Second Address | Highland Park, IL 60035-3200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U79175 | (02) | IL |