Provider Demographics
NPI:1447223821
Name:DIEDE, CLYDE A (DC)
Entity Type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:A
Last Name:DIEDE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 SOUTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINNER
Mailing Address - State:SD
Mailing Address - Zip Code:57580-1728
Mailing Address - Country:US
Mailing Address - Phone:605-842-0544
Mailing Address - Fax:605-842-0544
Practice Address - Street 1:337 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:WINNER
Practice Address - State:SD
Practice Address - Zip Code:57580-1728
Practice Address - Country:US
Practice Address - Phone:605-842-0544
Practice Address - Fax:605-842-0544
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2017-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD826111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0003826OtherBCBS
SD7600320Medicaid
ND18336OtherMEDICAID
410238OtherACN
NE26403OtherBCBS
241873OtherMIDLANDS CHOICE
33246OtherSIOUX VALLEY HEALTH PLAN
S3826Medicare ID - Type Unspecified
NE26403OtherBCBS