Healthcare Provider Details

I. General information

NPI: 1891049367
Provider Name (Legal Business Name): AGAPE MASSAGE THERAPY AND CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40410 HAYES RD
CLINTON TOWNSHIP MI
48038-2542
US

IV. Provider business mailing address

40410 HAYES RD
CLINTON TOWNSHIP MI
48038-2542
US

V. Phone/Fax

Practice location:
  • Phone: 586-464-0053
  • Fax: 586-464-0063
Mailing address:
  • Phone: 586-464-0053
  • Fax: 586-464-0063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301007308
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2301007308
License Number StateMI

VIII. Authorized Official

Name: CRAIG STASIO
Title or Position: OWNER AND PRESIDENT
Credential: D.C.
Phone: 586-464-0053