Provider Demographics
NPI:1801801345
Name:SASO, RANDOLPH JOHN
Entity type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:JOHN
Last Name:SASO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 ROUTE 83
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-3906
Mailing Address - Country:US
Mailing Address - Phone:630-655-9004
Mailing Address - Fax:
Practice Address - Street 1:6800 ROUTE 83
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-3906
Practice Address - Country:US
Practice Address - Phone:630-655-9004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2219989OtherBLUECROSS BLUESHIELD
IL999340Medicare ID - Type Unspecified
IL2219989OtherBLUECROSS BLUESHIELD