| NPI | 1104018373 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON D ROTH Owner 218-233-2517 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 3113) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 3114) |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2016-02-04 |