Provider Demographics
NPI:1346670759
Name:TANNING SHACK INC
Entity Type:Organization
Organization Name:TANNING SHACK INC
Other - Org Name:SUN SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:SALOMONIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:303-989-3656
Mailing Address - Street 1:1057 S WADSWORTH BLVD STE 90
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-4362
Mailing Address - Country:US
Mailing Address - Phone:303-989-3656
Mailing Address - Fax:303-989-3757
Practice Address - Street 1:1057 S WADSWORTH BLVD STE 90
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-4362
Practice Address - Country:US
Practice Address - Phone:303-989-3656
Practice Address - Fax:303-989-3757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0014860225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty