MEDICARE: AGAPE MASSAGE THERAPY AND CHIROPRACTIC PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	2301007308	MI
2	111N00000X	Chiropractor	2301007308	MI

General Provider Information

NPI Number	:	1891049367
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAPE MASSAGE THERAPY AND CHIROPRACTIC PLLC

Provider Business Mailing Address
First Line	:	40410 HAYES RD
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-2542
Country	:	US
Telephone Number	:	586-464-0053
Fax Number	:	586-464-0063

Provider Business Practice Location Address
First Line	:	40410 HAYES RD
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-2542
Country	:	US
Telephone Number	:	586-464-0053
Fax Number	:	586-464-0063

Authorized Official
Title or Position	:	OWNER AND PRESIDENT
Name	:	CRAIG STASIO
Credential	:	D.C.
Telephone Number	:	586-464-0053

Provider Enumeration Date	:	11/05/2012
Last Update Date	:	03/25/2013

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