Provider Demographics
NPI:1841379674
Name:HYNAN, JOHN J (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:HYNAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-1959
Mailing Address - Country:US
Mailing Address - Phone:651-222-7331
Mailing Address - Fax:651-222-8665
Practice Address - Street 1:475 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-1959
Practice Address - Country:US
Practice Address - Phone:651-222-7331
Practice Address - Fax:651-222-8665
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2114111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN724228000Medicaid
MN724228000Medicaid