Provider Demographics
NPI:1588120554
Name:AGAPE SPORTS & FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:AGAPE SPORTS & FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR/MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOB
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUGLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP
Authorized Official - Phone:702-410-5354
Mailing Address - Street 1:2790 W HORIZON RIDGE PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3997
Mailing Address - Country:US
Mailing Address - Phone:702-410-5354
Mailing Address - Fax:702-483-6798
Practice Address - Street 1:2790 W HORIZON RIDGE PKWY STE 110
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3997
Practice Address - Country:US
Practice Address - Phone:702-410-5354
Practice Address - Fax:702-483-6798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty