Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 14072 | TX |
N | 111N00000X | Chiropractor | 4366 | NC |
NPI | 1003259722 |
---|---|
Provider Name | Mr. Zachary James Roth |
First Address | San Antonio, TX 78270-0688 |
Second Address | Schertz, TX 78154-1457 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2013 |
Last Update Date | 26/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14072 | TEXAS BOARD OF CHIROPRACTIC (01) | TX |