Provider Demographics
NPI:1851963821
Name:AXTELL, BRITTANI JEAN (DTCM, LAC)
Entity Type:Individual
Prefix:DR
First Name:BRITTANI
Middle Name:JEAN
Last Name:AXTELL
Suffix:
Gender:F
Credentials:DTCM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4312
Mailing Address - Country:US
Mailing Address - Phone:530-306-1030
Mailing Address - Fax:
Practice Address - Street 1:200 7TH AVE STE 135
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-4670
Practice Address - Country:US
Practice Address - Phone:831-479-1592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-10
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19154171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist