Provider Demographics
NPI:1386861029
Name:HAEFNER, JON (DC)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:
Last Name:HAEFNER
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 1:205 2TH ST SW
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201
Mailing Address - Country:US
Mailing Address - Phone:320-214-0044
Mailing Address - Fax:
Practice Address - Street 1:205 2TH ST SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201
Practice Address - Country:US
Practice Address - Phone:320-214-0044
Practice Address - Fax:320-214-0045
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4176111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN062M2HAOtherBCBS PROVIDER
MN350002715Medicare PIN
MN062M2HAOtherBCBS PROVIDER