Individual
JOHN DICKINSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7467 SAINT ANDREWS RD, #9, IRMO, SC 29063-2875
(609) 602-3207
Mailing address
1100 PULASKI ST, APT 225, COLUMBIA, SC 29201-3644
(609) 602-3207
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1349
SC
Other
Enumeration date
11/19/2014
Last updated
11/19/2014
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