Provider Demographics
NPI:1063897031
Name:THE MANE ATRRACTION ON CLEMSON
Entity type:Organization
Organization Name:THE MANE ATRRACTION ON CLEMSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/STYLIST
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-447-0428
Mailing Address - Street 1:2000 CLEMSON RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9538
Mailing Address - Country:US
Mailing Address - Phone:803-788-7832
Mailing Address - Fax:
Practice Address - Street 1:2000 CLEMSON RD
Practice Address - Street 2:SUITE 5
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-9538
Practice Address - Country:US
Practice Address - Phone:803-788-7832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROWN SWEET MELLOW
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier