Provider Demographics
NPI:1679445795
Name:EQUINOX WELLNESS CENTER
Entity type:Organization
Organization Name:EQUINOX WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUTALOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-801-7300
Mailing Address - Street 1:1334 E PIONEER PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-6411
Mailing Address - Country:US
Mailing Address - Phone:817-801-7300
Mailing Address - Fax:888-549-2996
Practice Address - Street 1:1334 E PIONEER PKWY STE A
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-6411
Practice Address - Country:US
Practice Address - Phone:817-801-7300
Practice Address - Fax:888-549-2996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-18
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty