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General NPI Number Information
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NPI Number | 1114114642
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Entity Type | Organization
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Legal Business Name | INNATE & HYACK FAMILY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 09/28/2007
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Last Update Date | 12/05/2012
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Provider Practice Location Address
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Address Line | 2626 E 82ND ST #103
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City | BLOOMINGTON
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State | MN
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Zip | 55425-1300
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Country | US
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Telephone | 952-854-0057
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Fax | 952-854-0058
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Provider Business Mailing Address
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Address Line | 2626 E 82ND ST #103
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City | BLOOMINGTON
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State | MN
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Zip | 55425-1300
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Country | US
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Telephone | 952-854-0057
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Fax | 952-854-0058
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY ROBERT HYACK
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Credential | D.C, B.S.
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Telephone | 952-854-0057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4518
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License Number State | MN
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