Provider Demographics
NPI:1841252079
Name:BENNETT, KAI MG (DC)
Entity type:Individual
Prefix:DR
First Name:KAI
Middle Name:MG
Last Name:BENNETT
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 1:2225 E 7TH AVE
Mailing Address - Street 2:STE. A & B
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-3721
Mailing Address - Country:US
Mailing Address - Phone:928-226-9195
Mailing Address - Fax:928-226-9167
Practice Address - Street 1:2225 E 7TH AVE
Practice Address - Street 2:STE. A & B
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-3721
Practice Address - Country:US
Practice Address - Phone:928-226-9195
Practice Address - Fax:928-226-9167
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor