Nicole Leigh Sdao, D.C.

Primary specialty

Orthopedic ChiropractorTaxonomy code 111NX0800X

License

038-008743 Issued in IL

Practice address

455 W Stephenson St
Freeport, IL 61032-5001

Phone

(815) 232-4217

Fax

(815) 233-3379

NPI assigned

Jul 28, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 6

Other names 1

• Dr. Nicole Leigh Bahnub Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Specialty

Chiropractic

Education

National College of Chiropractic, 1998

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386288000000",
    "number": "1962416867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 W STEPHENSON ST",
            "city": "FREEPORT",
            "state": "IL",
            "postal_code": "610325001",
            "telephone_number": "815-232-4217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 W STEPHENSON ST",
            "city": "FREEPORT",
            "state": "IL",
            "postal_code": "610325001",
            "telephone_number": "815-232-4217",
            "fax_number": "815-233-3379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SDAO",
        "first_name": "NICOLE",
        "middle_name": "LEIGH",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-28",
        "last_updated": "2013-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NX0800X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Orthopedic",
            "state": "IL",
            "license": "038-008743",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD #",
            "identifier": "08925958",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD #",
            "identifier": "350049409",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ICHP TAX I.D. #",
            "identifier": "36-3581491",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRACTICE CORP. TAX I.D.#",
            "identifier": "75-3157454",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "038-008743",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE MEMBER #",
            "identifier": "K13271",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "BAHNUB",
            "middle_name": "LEIGH",
            "prefix": "DR.",
            "credential": "D.C.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Orthopedic Chiropractor in Freeport, IL
• Providers in Freeport, IL by specialty
• Orthopedic Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.