Individual
MR. JON DALE DIECKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
506 LINCOLN CV, MADISON, MS 39110-7337
(601) 853-7765
Mailing address
506 LINCOLN CV, MADISON, MS 39110-7337
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0059
MS
Other
Enumeration date
11/08/2006
Last updated
07/08/2007
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