Bedazzled Salon and Spa
Organization Active NPI Specialist · Roscoe, IL
NPI 1124309919 · NPPES record last updated Sep 7, 2011
Key facts
- NPI
- 1124309919
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- Legal business name
- BEDAZZLED SALON AND SPA
- Practice address
- 11708 Main St
Roscoe, IL 61073-9566 - Phone
- (815) 389-4965
- NPI assigned
- Sep 7, 2011
- Organization subpart
- No
Authorized official
- Name
- Anthony Jenkins
- Title
- Owner
- Phone
- (815) 389-4965
National Provider Directory
Locations
11708 Main St
Roscoe, IL 61073
Phone (815) 389-4965
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | Yes |
Addresses
Primary practice location
11708 Main St
Roscoe, IL 61073-9566
Mailing address
11708 Main St
Roscoe, IL 61073-9566
Other providers in Roscoe, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 7, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.