Individual
IAN DAVID LACKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
414 E CLARK ST, VERMILLION, SD 57069-2307
(605) 658-5541
Mailing address
722 LINCOLN ST, APT 200, VERMILLION, SD 57069-2401
(605) 658-5541
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0460
SD
Other
Enumeration date
10/04/2016
Last updated
10/04/2016
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