Provider Demographics
NPI:1093933087
Name:ROTH, SHARON C (DC)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:C
Last Name:ROTH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 OLD HICKORY BLVD.
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209
Mailing Address - Country:US
Mailing Address - Phone:615-352-9379
Mailing Address - Fax:615-352-1171
Practice Address - Street 1:600 OLD HICKORY BLVD.
Practice Address - Street 2:SUITE 104
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209
Practice Address - Country:US
Practice Address - Phone:615-352-9379
Practice Address - Fax:615-352-1171
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001157111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0070172OtherBCBS PROVIDER NUMBER
TN3674000Medicare PIN
TN0070172OtherBCBS PROVIDER NUMBER