Provider Demographics
NPI:1245225390
Name:VARNER-OTNESS, RITA RAE (DC)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:RAE
Last Name:VARNER-OTNESS
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 1:110 DIVISION ST E
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-1525
Mailing Address - Country:US
Mailing Address - Phone:763-682-1471
Mailing Address - Fax:763-682-7030
Practice Address - Street 1:110 DIVISION ST E
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-1525
Practice Address - Country:US
Practice Address - Phone:763-682-1471
Practice Address - Fax:763-682-7030
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2134111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT66249Medicare UPIN