Provider Demographics
NPI:1881653970
Name:ROTH, ELIZABETH E (DC)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:E
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 1:17627 TYCOON AVE
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:CO
Mailing Address - Zip Code:80465
Mailing Address - Country:US
Mailing Address - Phone:303-697-3888
Mailing Address - Fax:303-697-3889
Practice Address - Street 1:17627 TYCOON AVE
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:CO
Practice Address - Zip Code:80465
Practice Address - Country:US
Practice Address - Phone:303-697-3888
Practice Address - Fax:303-697-3889
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2253111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC801680Medicare PIN