Provider Demographics
NPI:1457985251
Name:IXI WELLNESS DALLAS LLC
Entity Type:Organization
Organization Name:IXI WELLNESS DALLAS LLC
Other - Org Name:BIO TESTING LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:STRADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-739-9199
Mailing Address - Street 1:10303 NORTHWEST FWY STE 263
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-8299
Mailing Address - Country:US
Mailing Address - Phone:855-239-3554
Mailing Address - Fax:
Practice Address - Street 1:10303 NORTHWEST FWY STE 263
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-8299
Practice Address - Country:US
Practice Address - Phone:855-239-3554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory