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General NPI Number Information
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NPI Number | 1083046072
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Entity Type | Organization
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Legal Business Name | HERITAGE SALON AND SPA,LLC
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Dates
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Enumeration Date | 08/01/2013
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Last Update Date | 08/01/2013
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Provider Practice Location Address
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Address Line | 5009 LEMAY FERRY RD
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City | SAINT LOUIS
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State | MO
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Zip | 63129-1531
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Country | US
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Telephone | 314-487-9723
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Fax |
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Provider Business Mailing Address
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Address Line | 5009 LEMAY FERRY RD
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City | SAINT LOUIS
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State | MO
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Zip | 63129-1531
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Country | US
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Telephone | 314-487-9723
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DENA LOW
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Credential |
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Telephone | 314-487-9723
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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