Provider Demographics
NPI:1710992375
Name:RONDEAU, SEAN PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:PAUL
Last Name:RONDEAU
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 W MORTON AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-3165
Mailing Address - Country:US
Mailing Address - Phone:217-243-2811
Mailing Address - Fax:217-243-4939
Practice Address - Street 1:1111 W MORTON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-3165
Practice Address - Country:US
Practice Address - Phone:217-243-2811
Practice Address - Fax:217-243-4939
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007996111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL06932004OtherBLUE CROSS BLUE SHIELD IL
IL329489OtherHEALTHLINK
IL06932004OtherBLUE CROSS BLUE SHIELD IL
ILU58485Medicare UPIN