Individual
MR. DAVID MICHAEL JACONSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
500 HIOAKS RD, RICHMOND, VA 23225
(804) 560-6518
Mailing address
1430 PALMORE RD, POWHATAN, VA 23139
(804) 403-3636
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126000365
VA
Other
Enumeration date
04/19/2007
Last updated
07/08/2007
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