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General NPI Number Information
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NPI Number | 1467864512
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Entity Type | Organization
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Legal Business Name | ALICE II SALONS
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Dates
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Enumeration Date | 05/23/2014
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Last Update Date | 05/23/2014
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Provider Practice Location Address
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Address Line | 311 QUADR,.
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City | BOLINGBROOK
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State | IL
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Zip | 60440
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Country | US
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Telephone | 630-378-9707
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Fax | 815-436-2009
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Provider Business Mailing Address
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Address Line | 311 QUADRANGLE DR
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City | BOLINGBROOK
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State | IL
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Zip | 60440
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Country | US
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Telephone | 630-378-9707
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Fax | 815-436-2009
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Authorized Official
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Title or Position | COSMETOLOGIST/INSTRACTOR
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Name | APRIL LYNN TOLIVER
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Credential | CERTIFIED HAIR LOSS
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Telephone | 815-483-4247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number |
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License Number State |
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