Provider Demographics
NPI:1174851026
Name:RANDALL L. ROTH, D.C.-P.C.
Entity Type:Organization
Organization Name:RANDALL L. ROTH, D.C.-P.C.
Other - Org Name:HEALTH 1ST WELLNESS & PHYSICAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-532-5565
Mailing Address - Street 1:804 HIGDON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6129
Mailing Address - Country:US
Mailing Address - Phone:214-532-5565
Mailing Address - Fax:501-881-4407
Practice Address - Street 1:804 HIGDON FERRY RD
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6129
Practice Address - Country:US
Practice Address - Phone:501-881-4407
Practice Address - Fax:501-881-4407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-03
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1219111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty