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Contact Information

JACKSON R DIEDE, MAT, ATC
810 E 23RD ST
SIOUX FALLS, SD57105-2135
 Phone: 605-331-5890
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Sports Medicine

2081S0010X 25 Physician/Physical Medicine and Rehabilitation
Indicates primary specialty

NPI Profile & details for JACKSON R DIEDE · (Male)

NPI Number 1760054373
Status Active
Credentials MAT, ATC
Entity Individual
Enumeration date 07/13/2021
Last updated 07/13/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • SD License # 0714
  • SD Other WSLW01080864 BLUECROSS BLUESHIELD
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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