Provider Demographics
NPI:1528720695
Name:HOUSE OF LUX SPA
Entity type:Organization
Organization Name:HOUSE OF LUX SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAYDEN
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:ROSENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:622-707-1620
Mailing Address - Street 1:4833 MINNETONKA BLVD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2214
Mailing Address - Country:US
Mailing Address - Phone:612-707-1620
Mailing Address - Fax:
Practice Address - Street 1:4833 MINNETONKA BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2214
Practice Address - Country:US
Practice Address - Phone:612-707-1620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSE OF LUX SPA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty