Provider Demographics
NPI:1740324490
Name:STEVEN D AGLER DC PLLC
Entity type:Organization
Organization Name:STEVEN D AGLER DC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:AGLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-463-7655
Mailing Address - Street 1:68407 TERRITORIAL RD
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-9318
Mailing Address - Country:US
Mailing Address - Phone:269-463-7655
Mailing Address - Fax:269-463-3698
Practice Address - Street 1:68407 TERRITORIAL RD
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-9318
Practice Address - Country:US
Practice Address - Phone:269-463-7655
Practice Address - Fax:269-463-3698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004892111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherTAX ID
MI0P07410Medicare ID - Type UnspecifiedGROUP PROVIDER NO