Provider Demographics
NPI:1073940771
Name:HINDERKS CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:HINDERKS CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HINDERKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-329-8185
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:RENVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56284-0459
Mailing Address - Country:US
Mailing Address - Phone:320-329-8185
Mailing Address - Fax:320-329-8186
Practice Address - Street 1:317 N MAIN ST.
Practice Address - Street 2:
Practice Address - City:RENVILLE
Practice Address - State:MN
Practice Address - Zip Code:56284
Practice Address - Country:US
Practice Address - Phone:320-329-8185
Practice Address - Fax:320-329-8186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-26
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5098111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty