Provider Demographics
NPI:1164023271
Name:ROTH, ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
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 1:1795 ALYSHEBA WAY
Mailing Address - Street 2:STE 4103
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2488
Mailing Address - Country:US
Mailing Address - Phone:859-335-0419
Mailing Address - Fax:
Practice Address - Street 1:3650 BOSTON RD STE 188
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40514-1502
Practice Address - Country:US
Practice Address - Phone:859-219-0626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY267010111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor