MEDICARE: DR. JESSE LEVI ROTH D.C.

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	10580	TX

General Provider Information

NPI Number	:	1225243033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSE LEVI ROTH D.C.

Provider Business Mailing Address
First Line	:	2510 WASHINGTON AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-6021
Country	:	US
Telephone Number	:	713-802-9188
Fax Number	:	713-802-2278

Provider Business Practice Location Address
First Line	:	2510 WASHINGTON AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-6021
Country	:	US
Telephone Number	:	713-802-9188
Fax Number	:	713-802-2278

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	06/02/2009

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