Provider Demographics
NPI:1235229287
Name:HINZ, JOHN ADAM (MSOM, LAC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ADAM
Last Name:HINZ
Suffix:
Gender:M
Credentials:MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-4961
Mailing Address - Country:US
Mailing Address - Phone:262-309-2412
Mailing Address - Fax:
Practice Address - Street 1:411 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-4961
Practice Address - Country:US
Practice Address - Phone:262-547-1411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI290-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist