Provider Demographics
NPI:1639266109
Name:VARNER, JEFFREY JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JOHN
Last Name:VARNER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:JOHN
Other - Last Name:VARNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:251 COUNTY ROAD 120
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4872
Mailing Address - Country:US
Mailing Address - Phone:320-252-3711
Mailing Address - Fax:
Practice Address - Street 1:251 CO RD 120
Practice Address - Street 2:SUITE B
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4886
Practice Address - Country:US
Practice Address - Phone:320-252-3711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2457111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3C206CROtherBLUE CROSS BLUE SHIELD
MN670028400Medicaid
MN359000168Medicare ID - Type Unspecified
MNT-70889Medicare UPIN