Provider Demographics
NPI:1942274832
Name:ROTH, BRIAN S (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:S
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 1:3006 NEW PARK CIR
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-4077
Mailing Address - Country:US
Mailing Address - Phone:215-412-8258
Mailing Address - Fax:
Practice Address - Street 1:20 S TROOPER RD
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19403-3050
Practice Address - Country:US
Practice Address - Phone:610-539-5000
Practice Address - Fax:610-539-8350
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007534L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARO 028878Medicare ID - Type Unspecified