Provider Demographics
NPI:1255403507
Name:HYZNY, VICTORIA L (DC)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:L
Last Name:HYZNY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 734
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60454-0734
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12261 W 159TH ST
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-7847
Practice Address - Country:US
Practice Address - Phone:708-301-2255
Practice Address - Fax:708-301-2631
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5586552OtherAETNA
IL01622580OtherBLUE CROSS BLUE SHIELD
IL01622580OtherBLUE CROSS BLUE SHIELD
ILU61512Medicare UPIN