Provider Demographics
NPI:1295809713
Name:ROYER, SEAN D (DC)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:D
Last Name:ROYER
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 1:1770 1ST ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3200
Mailing Address - Country:US
Mailing Address - Phone:847-926-8835
Mailing Address - Fax:847-926-8837
Practice Address - Street 1:1770 1ST ST
Practice Address - Street 2:SUITE 400
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3200
Practice Address - Country:US
Practice Address - Phone:847-926-8835
Practice Address - Fax:847-926-8837
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL485890Medicare ID - Type UnspecifiedMEDICARE NUMBER
ILU79175Medicare UPIN