Provider Demographics
NPI:1629347232
Name:CENTOFANTI CHIROPRACTIC CENTER, PC
Entity Type:Organization
Organization Name:CENTOFANTI CHIROPRACTIC CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:CENTOFANTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP
Authorized Official - Phone:989-635-3828
Mailing Address - Street 1:3085 MAIN ST
Mailing Address - Street 2:PO BOX 245
Mailing Address - City:MARLETTE
Mailing Address - State:MI
Mailing Address - Zip Code:48453-1243
Mailing Address - Country:US
Mailing Address - Phone:989-635-3828
Mailing Address - Fax:
Practice Address - Street 1:3085 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLETTE
Practice Address - State:MI
Practice Address - Zip Code:48453-1243
Practice Address - Country:US
Practice Address - Phone:989-635-3828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-28
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
MI2301005491261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty