Provider Demographics
NPI:1407974538
Name:CAVACIUTI, ERIC ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ANTHONY
Last Name:CAVACIUTI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:557 RIVERSTONE PKWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5223
Mailing Address - Country:US
Mailing Address - Phone:770-345-2000
Mailing Address - Fax:770-345-4524
Practice Address - Street 1:557 RIVERSTONE PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5223
Practice Address - Country:US
Practice Address - Phone:770-345-2000
Practice Address - Fax:770-345-4524
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GACHIR007378111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACHIR007378Medicare UPIN