Provider Demographics
NPI:1265861405
Name:MANE EVENT SALON LLC
Entity Type:Organization
Organization Name:MANE EVENT SALON LLC
Other - Org Name:MANE EVENT SALON LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CERTIFIED HAIR LOSS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:EUGENIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIEDHAIRLOSSSPE
Authorized Official - Phone:423-468-3425
Mailing Address - Street 1:5525 SAINT ELMO AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37409-2312
Mailing Address - Country:US
Mailing Address - Phone:423-468-3425
Mailing Address - Fax:
Practice Address - Street 1:5525 SAINT ELMO AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37409-2312
Practice Address - Country:US
Practice Address - Phone:423-468-3425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty