Provider Demographics
NPI:1922662048
Name:HAIRLAB CHICAGO
Entity Type:Organization
Organization Name:HAIRLAB CHICAGO
Other - Org Name:HAIRLAB CHICAGO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:ANSAY
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-732-3841
Mailing Address - Street 1:281 WAUKEGAN RD STE 2
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2718
Mailing Address - Country:US
Mailing Address - Phone:847-999-9585
Mailing Address - Fax:
Practice Address - Street 1:281 WAUKEGAN RD STE 2
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-2718
Practice Address - Country:US
Practice Address - Phone:847-999-9585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty