Provider Demographics
NPI:1043089733
Name:AESTHETIC LUXURY SPA LLC
Entity type:Organization
Organization Name:AESTHETIC LUXURY SPA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-200-2409
Mailing Address - Street 1:2301 TROOST AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108
Mailing Address - Country:US
Mailing Address - Phone:816-200-2409
Mailing Address - Fax:
Practice Address - Street 1:2301 TROOST AVE
Practice Address - Street 2:STE 101
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108
Practice Address - Country:US
Practice Address - Phone:816-200-2409
Practice Address - Fax:816-320-0028
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AESTHETIC LUXURY SPA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-22
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care