Provider Demographics
NPI:1043645724
Name:GREG JOCKEL HAIR DESIGNERS, INC.
Entity Type:Organization
Organization Name:GREG JOCKEL HAIR DESIGNERS, INC.
Other - Org Name:GREG JOCKEL HAIR COLOUR DESIGN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:JOCKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-934-0211
Mailing Address - Street 1:12041 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8394
Mailing Address - Country:US
Mailing Address - Phone:724-934-0211
Mailing Address - Fax:724-935-3747
Practice Address - Street 1:12041 PERRY HWY
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8394
Practice Address - Country:US
Practice Address - Phone:724-934-0211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACB089234L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty