Provider Demographics
NPI:1154474252
Name:AGAPES ACUPUNCTURE, SC
Entity Type:Organization
Organization Name:AGAPES ACUPUNCTURE, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:POLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-337-9100
Mailing Address - Street 1:566 REDBIRD CIR
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-8796
Mailing Address - Country:US
Mailing Address - Phone:920-337-9100
Mailing Address - Fax:920-337-9101
Practice Address - Street 1:566 REDBIRD CIR
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-8796
Practice Address - Country:US
Practice Address - Phone:920-337-9100
Practice Address - Fax:920-337-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain