Provider Demographics
NPI:1073935730
Name:CENTOFANTI, ERIC T (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:T
Last Name:CENTOFANTI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20754 W DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1146
Mailing Address - Country:US
Mailing Address - Phone:305-935-9599
Mailing Address - Fax:
Practice Address - Street 1:1220 20TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139
Practice Address - Country:US
Practice Address - Phone:305-935-9599
Practice Address - Fax:305-932-5612
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12544111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician