MEDICARE: DR. MATTHEW J. 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	3396	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000313242	OTHER	OH	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275660136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW J. ROTH D.C.

Provider Business Mailing Address
First Line	:	3187 WESTERN ROW RD
Second Line	:	SUITE 114
City	:	MAINEVILLE
State	:	OH
Zip	:	45039-8045
Country	:	US
Telephone Number	:	513-770-3434
Fax Number	:	513-229-5432

Provider Business Practice Location Address
First Line	:	3187 WESTERN ROW RD
Second Line	:	SUITE 114
City	:	MAINEVILLE
State	:	OH
Zip	:	45039-8045
Country	:	US
Telephone Number	:	513-770-3434
Fax Number	:	513-229-5432

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	10/03/2012

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