Individual
DR. JACOB JOHN ROETHLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
1301 DIAGONAL RD, WORTHINGTON, MN 56187-1114
(507) 376-9663
(507) 376-9663
Mailing address
1301 DIAGONAL RD, WORTHINGTON, MN 56187-1114
(507) 376-9663
(507) 376-9663
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4388
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
072H1RO
BLUE CROSS BLUE SHIELD
MN
Enumeration date
09/20/2006
Last updated
07/08/2007
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