Provider Demographics
NPI:1053363077
Name:HINDERMAN, JACK DANIEL (DC)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:DANIEL
Last Name:HINDERMAN
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 1:998 FREMONT AVE
Mailing Address - Street 2:STE. L1
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003-0300
Mailing Address - Country:US
Mailing Address - Phone:563-556-6921
Mailing Address - Fax:563-556-6923
Practice Address - Street 1:998 FREMONT AVE
Practice Address - Street 2:STE. L1
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52003-0300
Practice Address - Country:US
Practice Address - Phone:563-556-6921
Practice Address - Fax:563-556-6923
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06886111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor