Provider Demographics
NPI:1205100690
Name:COUNTRY HAIR STUDIO
Entity type:Organization
Organization Name:COUNTRY HAIR STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUNKELBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:717-314-8295
Mailing Address - Street 1:322 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:PA
Mailing Address - Zip Code:17517-1448
Mailing Address - Country:US
Mailing Address - Phone:717-336-4500
Mailing Address - Fax:
Practice Address - Street 1:322 MAIN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:PA
Practice Address - Zip Code:17517-1448
Practice Address - Country:US
Practice Address - Phone:717-336-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty