Healthcare Provider Details

I. General information

NPI: 1477187748
Provider Name (Legal Business Name): MOXIE ALLURE CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 SOUTH BLVD
OAK PARK IL
60302-2921
US

IV. Provider business mailing address

327 SOUTH BLVD
OAK PARK IL
60302-2921
US

V. Phone/Fax

Practice location:
  • Phone: 773-407-1043
  • Fax: 888-267-0201
Mailing address:
  • Phone: 301-204-9541
  • Fax: 888-267-0201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZA2600X
TaxonomyMedical Art Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MS. KHAREL WEIR
Title or Position: OFFICE MANAGER
Credential:
Phone: 301-204-9541