Individual
DR. LARS LYLE ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
39 E SHERIDAN, ELY, MN 55731
(218) 365-5770
Mailing address
PO BOX 659, ELY, MN 55731
(218) 365-5770
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
01263
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
73220R0
BCBS OF MN
MN
01
—
908225500
MN HEALTH CARE PROGRAMS
MN
Enumeration date
08/29/2006
Last updated
08/23/2010
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