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General NPI Number Information
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NPI Number | 1477187748
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Entity Type | Organization
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Legal Business Name | MOXIE ALLURE CO.
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Dates
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Enumeration Date | 02/26/2020
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Last Update Date | 02/26/2020
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Provider Practice Location Address
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Address Line | 327 SOUTH BLVD
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City | OAK PARK
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State | IL
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Zip | 60302-2921
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Country | US
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Telephone | 773-407-1043
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Fax | 888-267-0201
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Provider Business Mailing Address
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Address Line | 327 SOUTH BLVD
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City | OAK PARK
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State | IL
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Zip | 60302-2921
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Country | US
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Telephone | 301-204-9541
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Fax | 888-267-0201
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. KHAREL WEIR
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Credential |
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Telephone | 301-204-9541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZA2600X
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Taxonomy Name | Medical Art Specialist/Technologist
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License Number |
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License Number State |
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