Individual
DR. STACEY ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
1906 30TH AVE S, MOORHEAD, MN 56560-5210
(218) 233-2517
Mailing address
1906 30TH AVE S, MOORHEAD, MN 56560-5210
(218) 233-2517
Taxonomy
Speciality
Code
Description
License number
State
111NP0017X
Pediatric Chiropractor
Primary
3114
MN
Other
Enumeration date
04/02/2012
Last updated
04/02/2012
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