Provider Demographics
NPI:1972962413
Name:CENTOFANTI, JORDON (DC)
Entity Type:Individual
Prefix:
First Name:JORDON
Middle Name:
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 1:43 LAS OLAS DR
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-7647
Mailing Address - Country:US
Mailing Address - Phone:732-684-9620
Mailing Address - Fax:
Practice Address - Street 1:1957 ROUTE 88 E
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3151
Practice Address - Country:US
Practice Address - Phone:732-684-9620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-12
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00733800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor