MEDICARE: DR. BRIAN S 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	DC007534L	PA

General Provider Information

NPI Number	:	1942274832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN S ROTH D.C.

Provider Business Mailing Address
First Line	:	3006 NEW PARK CIR
Second Line	:
City	:	LANSDALE
State	:	PA
Zip	:	19446-4077
Country	:	US
Telephone Number	:	215-412-8258
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 S TROOPER RD
Second Line	:
City	:	NORRISTOWN
State	:	PA
Zip	:	19403-3050
Country	:	US
Telephone Number	:	610-539-5000
Fax Number	:	610-539-8350

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	07/01/2011

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