Provider Demographics
NPI:1972338648
Name:XI WAVE CLINIC
Entity type:Organization
Organization Name:XI WAVE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ABORIGINAL NATUROPATH DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KOJO
Authorized Official - Middle Name:
Authorized Official - Last Name:XI SHABAZZ
Authorized Official - Suffix:
Authorized Official - Credentials:NPD
Authorized Official - Phone:580-475-1399
Mailing Address - Street 1:2152 STEER CREEK PL
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-3135
Mailing Address - Country:US
Mailing Address - Phone:405-615-9849
Mailing Address - Fax:
Practice Address - Street 1:2152 STEER CREEK PL
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-3135
Practice Address - Country:US
Practice Address - Phone:580-475-1399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty