Provider Demographics
NPI:1891165395
Name:ROTH, RYAN N (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:N
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 1:212 WOODCREST ST
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6513
Mailing Address - Country:US
Mailing Address - Phone:501-326-8979
Mailing Address - Fax:
Practice Address - Street 1:3525 HWY 5 N STE 200
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72019-9092
Practice Address - Country:US
Practice Address - Phone:501-333-6654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2022-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16097111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor