Provider Demographics
NPI:1073542858
Name:CENTOFANTI, ERNEST RICHARD (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:RICHARD
Last Name:CENTOFANTI
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3078 MAIN ST
Mailing Address - Street 2:PO BOX 245
Mailing Address - City:MARLETTE
Mailing Address - State:MI
Mailing Address - Zip Code:48453-1292
Mailing Address - Country:US
Mailing Address - Phone:989-635-3828
Mailing Address - Fax:989-635-3828
Practice Address - Street 1:3078 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLETTE
Practice Address - State:MI
Practice Address - Zip Code:48453-0245
Practice Address - Country:US
Practice Address - Phone:989-635-3828
Practice Address - Fax:989-635-3828
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI005491111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950G65244OtherBLUE CROSS
MI2582862Medicaid
MI2582862Medicaid
MI950G65244OtherBLUE CROSS