Provider Demographics
NPI:1083092845
Name:ROTH, CHASE ANN (ND,LAC)
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:ANN
Last Name:ROTH
Suffix:
Gender:F
Credentials:ND,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 CHENOWETH LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2653
Mailing Address - Country:US
Mailing Address - Phone:502-410-8363
Mailing Address - Fax:
Practice Address - Street 1:161 CHENOWETH LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2653
Practice Address - Country:US
Practice Address - Phone:502-410-8363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAC014171100000X
VT099.0000159172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No172P00000XOther Service ProvidersNaprapath