Basic Information
| Provider Information | |||||||||
| NPI: | 1780702316 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENNETT | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | MARK | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ACUPUNCTURIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8326 W 87TH DR APT A | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800051665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034250887 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8725 WADSWORTH BLVD | ||||||||
| Address2: | |||||||||
| City: | ARVADA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800030928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034257298 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | 1246 | CO | Y | Other Service Providers | Acupuncturist |
No ID Information.