Organization
ROTH CHIROPRACTIC CLINIC LTD
Active
Parent organization
ROTH CHIROPRACTIC CLINIC LTD
Organization subpart
Yes
Provider details
NPI number
Legal business name
ROTH CHIROPRACTIC CLINIC LTD
Authorized official
DR. LARS LYLE ROTH D.C. (PRESIDENT)
(218) 365-5770
Entity
Organization
Contact information
Practice address
39 E SHERIDAN ST, ELY, MN 55731-1213
(218) 365-5770
(218) 365-5770
Mailing address
39 E SHERIDAN ST, P.O. BOX 659, ELY, MN 55731-1213
(218) 365-5770
(218) 365-5770
Taxonomy
Speciality
Code
Description
License number
State
111NX0800X
Orthopedic Chiropractor
Primary
1263
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
908225500
—
MN
Enumeration date
01/03/2012
Last updated
01/03/2012
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