JACKSON RAY DIEDE

SIOUX FALLS, SD
NPI1760054373
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy2081S0010X Physical Medicine & Rehabilitation, Sports Medicine
(Licence: SD  0714)
Enumeration Date2021-07-13
Last Update Date2021-07-13
Business Address
JACKSON RAY DIEDE MAT, ATC
810 E 23RD ST
SIOUX FALLS, SD 57105-2135
Phone number: 605-331-5890
Mailing Address
JACKSON RAY DIEDE MAT, ATC
117 S HIGH ST
MENNO, SD 57045-2170
Phone number: 605-760-1566
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