Provider Demographics
NPI:1053657924
Name:JAZZ HAIR INSTITUTE
Entity type:Organization
Organization Name:JAZZ HAIR INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COSMETOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-389-5770
Mailing Address - Street 1:3950 COOK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63113
Mailing Address - Country:US
Mailing Address - Phone:314-258-7061
Mailing Address - Fax:
Practice Address - Street 1:3950 COOK AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63113-3402
Practice Address - Country:US
Practice Address - Phone:314-258-7061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-21
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty