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General NPI Number Information
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NPI Number | 1205970456
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Entity Type | Individual
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Provider Name | JEFF DEKOSKI ATC
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Gender | Male
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 10/29/2008
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Provider Practice Location Address
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Address Line | 1200 S JAY ST
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City | ABERDEEN
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State | SD
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Zip | 57401-7155
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Country | US
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Telephone | 605-626-7733
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Fax |
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Provider Business Mailing Address
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Address Line | 1206 N 2ND ST
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City | ABERDEEN
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State | SD
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Zip | 57401-1918
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Country | US
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Telephone | 605-290-3454
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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