Individual
JONATHON DIERCKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, ATR, ATC
Contact information
Practice address
3800 AMERICAN BLVD W, SUITE 2, BLOOMINGTON, MN 55431-4420
(952) 993-9706
Mailing address
3800 AMERICAN BLVD W, SUITE 2, BLOOMINGTON, MN 55431-4420
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2597
MN
Other
Enumeration date
04/29/2015
Last updated
04/29/2015
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