Provider Demographics
NPI:1124272109
Name:SALON OHM, LLC
Entity type:Organization
Organization Name:SALON OHM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MIXON
Authorized Official - Suffix:
Authorized Official - Credentials:COSMETOLOGIST
Authorized Official - Phone:954-561-1002
Mailing Address - Street 1:2435 N DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-2239
Mailing Address - Country:US
Mailing Address - Phone:954-561-1002
Mailing Address - Fax:
Practice Address - Street 1:2435 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-2239
Practice Address - Country:US
Practice Address - Phone:954-561-1002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier