Healthcare Provider Details

I. General information

NPI: 1629347232
Provider Name (Legal Business Name): CENTOFANTI CHIROPRACTIC CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2011
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3085 MAIN ST
MARLETTE MI
48453-1243
US

IV. Provider business mailing address

3085 MAIN ST PO BOX 245
MARLETTE MI
48453-1243
US

V. Phone/Fax

Practice location:
  • Phone: 989-635-3828
  • Fax:
Mailing address:
  • Phone: 989-635-3828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number2301005491
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. ERNEST RICHARD CENTOFANTI
Title or Position: PRESIDENT
Credential: D.C., C.C.S.P.
Phone: 989-635-3828