Provider Demographics
NPI:1528269792
Name:ROTH CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:ROTH CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-770-3434
Mailing Address - Street 1:3187 WESTERN ROW RD STE 114
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-8014
Mailing Address - Country:US
Mailing Address - Phone:513-770-3434
Mailing Address - Fax:513-229-5432
Practice Address - Street 1:3187 WESTERN ROW RD STE 114
Practice Address - Street 2:
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039-8014
Practice Address - Country:US
Practice Address - Phone:513-770-3434
Practice Address - Fax:513-229-5432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9339201Medicare PIN