Provider Demographics
NPI:1003259722
Name:ROTH, ZACHARY JAMES (DC)
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:JAMES
Last Name:ROTH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 700688
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78270-0688
Mailing Address - Country:US
Mailing Address - Phone:210-477-7654
Mailing Address - Fax:210-468-0682
Practice Address - Street 1:5000 SCHERTZ PKWY STE 401
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1457
Practice Address - Country:US
Practice Address - Phone:800-404-6050
Practice Address - Fax:866-313-3397
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4366111N00000X
TX14072111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14072OtherTEXAS BOARD OF CHIROPRACTIC