Healthcare Provider Details

I. General information

NPI: 1184382970
Provider Name (Legal Business Name): THE B. DAVIS HAIR CARE SALON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 11/30/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 S EAST ST STE 107
INDIANAPOLIS IN
46227-2076
US

IV. Provider business mailing address

5401 S EAST ST STE 107
INDIANAPOLIS IN
46227-2076
US

V. Phone/Fax

Practice location:
  • Phone: 463-224-7952
  • Fax: 317-757-6101
Mailing address:
  • Phone: 463-224-7952
  • Fax: 317-757-6101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name: MS. BRANDI GENETTE SPENCER
Title or Position: OWNER
Credential: HAIR LOSS SPECIALIST
Phone: 463-224-7952