Provider Demographics
NPI:1154665677
Name:AGAPE CHIRO MED OF MICHIGAN, LLC
Entity Type:Organization
Organization Name:AGAPE CHIRO MED OF MICHIGAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PELLEGRINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-367-1333
Mailing Address - Street 1:731 NE 32ND ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6918
Mailing Address - Country:US
Mailing Address - Phone:561-367-1333
Mailing Address - Fax:564-136-1320
Practice Address - Street 1:1029 E SAGINAW STREET
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906
Practice Address - Country:US
Practice Address - Phone:561-367-1333
Practice Address - Fax:561-367-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009820111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty