Individual
KENNETH DILDINE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
1230 TOM GINNEVER AVE, O FALLON, MO 63366-4406
(636) 359-8884
Mailing address
25 DEER RUN TRL, NEW FLORENCE, MO 63363-3519
(636) 359-8884
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2018024370
MO
Other
Enumeration date
08/09/2018
Last updated
05/16/2023
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