Organization
INNATE & HYACK FAMILY CHIROPRACTIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY ROBERT HYACK D.C, B.S. (OWNER)
(952) 854-0057
Entity
Organization
Contact information
Practice address
2626 E 82ND ST, #103, BLOOMINGTON, MN 55425-1300
(952) 854-0057
(952) 854-0058
Mailing address
2626 E 82ND ST, #103, BLOOMINGTON, MN 55425-1300
(952) 854-0057
(952) 854-0058
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4518
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C04123
MEDICARE GROUP #
MN
Enumeration date
09/28/2007
Last updated
12/05/2012
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