# BRENT A ROTH DC INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033316419
- **Authorized official:** BRENT A ROTH DC (PRESIDENT)
- **Authorized official phone:** (419) 542-8247

## Contact information

- **Practice address:** 501 W HIGH ST, HICKSVILLE, OH 43526-1083
- **Practice address phone:** (419) 542-8247
- **Practice address fax:** (419) 542-6726
- **Mailing address:** 501 W HIGH ST, HICKSVILLE, OH 43526-1083
- **Mailing address phone:** (419) 542-8247
- **Mailing address fax:** (419) 542-6716

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | 719 | OH | Yes |

## Other

- **Enumeration date:** 06/29/2007
- **Last updated:** 08/22/2020