Provider Demographics
NPI:1063451490
Name:ROTH, LARRY R (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:R
Last Name:ROTH
Suffix:
Gender:M
Credentials:CHIROPRACTOR
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 8546
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71910-8546
Mailing Address - Country:US
Mailing Address - Phone:501-984-9977
Mailing Address - Fax:501-984-9979
Practice Address - Street 1:4501 N HIGHWAY 7
Practice Address - Street 2:SUITE 2
Practice Address - City:HOT SPRINGS VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71909-9799
Practice Address - Country:US
Practice Address - Phone:501-984-9977
Practice Address - Fax:501-984-9979
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR997111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR4420078OtherUNITED HEALTHCARE
AR59807OtherBLUE CROSS
AR4487383OtherAETNA
AR4487383OtherAETNA
AR4420078OtherUNITED HEALTHCARE