Provider Demographics
NPI:1558798512
Name:TIFFANI CHANELS BEAUTY SUPPLY, LLC
Entity Type:Organization
Organization Name:TIFFANI CHANELS BEAUTY SUPPLY, LLC
Other - Org Name:TIFFANI CHANEL LUXURY HAIR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANI
Authorized Official - Middle Name:
Authorized Official - Last Name:SPELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-755-9963
Mailing Address - Street 1:330 RAYFORD RD
Mailing Address - Street 2:211
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-1980
Mailing Address - Country:US
Mailing Address - Phone:317-755-9963
Mailing Address - Fax:
Practice Address - Street 1:2578 S LOOP W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2634
Practice Address - Country:US
Practice Address - Phone:317-755-9963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier