Provider Demographics
NPI:1639647266
Name:ROTH, ALLISON PAIGE (DC)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:PAIGE
Last Name:ROTH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:PAIGE
Other - Middle Name:
Other - Last Name:ROTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:2301 INGERSOLL AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5271
Mailing Address - Country:US
Mailing Address - Phone:515-612-7701
Mailing Address - Fax:
Practice Address - Street 1:2301 INGERSOLL AVE STE 200
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-5271
Practice Address - Country:US
Practice Address - Phone:515-612-7701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA092260111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor