Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 12544 | FL |
N | 111NS0005X | Chiropractic Sports Physician | 12544 | FL |
NPI | 1073935730 |
---|---|
Provider Name | Dr. Eric T Centofanti |
First Address | Aventura, FL 33180-1146 |
Second Address | Miami Beach, FL 33139 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2014 |
Last Update Date | 25/02/2019 |