Provider Demographics
NPI:1437482262
Name:BENNETT, LUCKY (ND)
Entity Type:Individual
Prefix:DR
First Name:LUCKY
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22301-1313
Mailing Address - Country:US
Mailing Address - Phone:571-228-9718
Mailing Address - Fax:
Practice Address - Street 1:2201 MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22301-1313
Practice Address - Country:US
Practice Address - Phone:571-228-9718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNP-0012175F00000X
WANT 60059890175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath