Provider Demographics
NPI:1396964888
Name:BENNETTS, ALEXIA R (LAC)
Entity type:Individual
Prefix:
First Name:ALEXIA
Middle Name:R
Last Name:BENNETTS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12380 W 64TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-4016
Mailing Address - Country:US
Mailing Address - Phone:303-467-5337
Mailing Address - Fax:303-467-1131
Practice Address - Street 1:12380 W 64TH AVE
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-4016
Practice Address - Country:US
Practice Address - Phone:303-467-5337
Practice Address - Fax:303-467-1131
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO607171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist