Provider Demographics
NPI:1225096829
Name:ROTH, RICHIE REED (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHIE
Middle Name:REED
Last Name:ROTH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32350 LA HIGHWAY 16
Mailing Address - Street 2:BLDG C
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-1463
Mailing Address - Country:US
Mailing Address - Phone:225-664-1456
Mailing Address - Fax:866-766-9895
Practice Address - Street 1:32350 LA HIGHWAY 16
Practice Address - Street 2:BLDG C
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-1463
Practice Address - Country:US
Practice Address - Phone:225-664-1456
Practice Address - Fax:866-766-9895
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1058111N00000X
AR1264111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA721506741OtherEMPLOYER IDENTIFICATION #
LA721506741OtherEMPLOYER IDENTIFICATION #