Individual
MR. DAVID CARROLL DICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
1.CERTIFIED PEDORTHI
Contact information
Practice address
612 W. SHERIDAN AVENUE, SHENANDOAH, IA 51601
(712) 246-2635
(712) 246-3933
Mailing address
612 W. SHERIDAN AVENUE, JAY DRUG C. (DCD PEDORTHICS), SHENANDOAH, IA 51601
(712) 246-2635
(712) 246-3933
Taxonomy
Speciality
Code
Description
License number
State
224L00000X
Pedorthist
Primary
074625
IA
246ZS0410X
Surgical Technologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
547455800
—
MN
Enumeration date
03/26/2007
Last updated
10/06/2015
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