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Individual

RICHARD CHARLES ROTH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.C.

Contact information

Practice address
655 CAMINO DE LOS MARES STE 121, SAN CLEMENTE, CA 92673-2809
(949) 498-3262
(949) 498-4718
Mailing address
655 CAMINO DE LOS MARES STE 121, SAN CLEMENTE, CA 92673-2809
(949) 498-3262
(949) 498-4718

Taxonomy

Speciality
Code
Description
License number
State
111NX0800X
Orthopedic Chiropractor
Primary
14746
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
DC0147460
BLUE SHIELD
CA
01
DC14746
CHIROPRACTIC LICENSE
CA
Enumeration date
01/12/2007
Last updated
03/31/2020
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