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General NPI Number Information
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NPI Number | 1356560122
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Entity Type | Organization
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Legal Business Name | ROTH CHIROPRACTIC, PA
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7064 BERACASA WAY
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City | BOCA RATON
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State | FL
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Zip | 33433-3447
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Country | US
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Telephone | 561-392-1777
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Fax | 561-750-2361
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Provider Business Mailing Address
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Address Line | 7064 BERACASA WAY
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City | BOCA RATON
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State | FL
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Zip | 33433-3447
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Country | US
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Telephone | 561-392-1777
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Fax | 561-750-2361
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Authorized Official
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Title or Position | OWNER,CHIROPRACTOR
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Name | DR. JOHN DAVID ROTH
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Credential | DC
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Telephone | 561-392-1777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH 3916
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License Number State | FL
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