Healthcare Provider Details

I. General information

NPI: 1740324490
Provider Name (Legal Business Name): STEVEN D AGLER DC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 10/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68407 TERRITORIAL RD
BENTON HARBOR MI
49022-9318
US

IV. Provider business mailing address

68407 TERRITORIAL RD
BENTON HARBOR MI
49022-9318
US

V. Phone/Fax

Practice location:
  • Phone: 269-463-7655
  • Fax: 269-463-3698
Mailing address:
  • Phone: 269-463-7655
  • Fax: 269-463-3698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301004892
License Number StateMI

VIII. Authorized Official

Name: STEVEN D AGLER
Title or Position: OWNER
Credential: DC
Phone: 269-463-7655