NPIMap

Organization Active NPI

Innate & Hyack Family Chiropractic LLC

  • Chiropractor
  • Bloomington, MN
National Provider Identifier
1114114642
Registry record updated Dec 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4518 Issued in MN
Legal business name
INNATE & HYACK FAMILY CHIROPRACTIC LLC
Practice address
2626 E 82ND St
#103
Bloomington, MN 55425-1300
Phone
(952) 854-0057
Fax
(952) 854-0058
NPI assigned
Sep 28, 2007
Last updated
Dec 5, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jeffrey Robert Hyack, D.C, B.S.NPI 1164564779
Title
Owner
Phone
(952) 854-0057

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 4518 MN Primary

Addresses

Primary practice location

2626 E 82ND St
#103
Bloomington, MN 55425-1300

Mailing address

2626 E 82ND St
#103
Bloomington, MN 55425-1300
Phone (952) 854-0057

Other identifiers 1

IdentifierTypeStateIssuer
C04123OtherMNMEDICARE GROUP #

National Provider Directory

National Provider Directory

Locations

2626 E 82nd St
Ste 103
Bloomington, MN 55425
Phone (952) 854-0057

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354665600000",
    "number": "1114114642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2626 E 82ND ST",
            "address_2": "#103",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554251300",
            "telephone_number": "952-854-0057",
            "fax_number": "952-854-0058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2626 E 82ND ST",
            "address_2": "#103",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554251300",
            "telephone_number": "952-854-0057",
            "fax_number": "952-854-0058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNATE & HYACK FAMILY CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-28",
        "last_updated": "2012-12-05",
        "status": "A",
        "authorized_official_last_name": "HYACK",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-854-0057",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C, B.S."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "4518",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP #",
            "identifier": "C04123",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.