MEDICARE: DR. GREGORY ROTH DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	013275	NY

General Provider Information

NPI Number	:	1720634082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY ROTH DC

Provider Business Mailing Address
First Line	:	1641 EAST AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14610-1604
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1641 EAST AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14610-1604
Country	:	US
Telephone Number	:	585-473-7746
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2019
Last Update Date	:	08/13/2019

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Directions to “ DR. GREGORY ROTH DC” Practice Location

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