Lars Lyle Roth is a Chiropractor based in Ely, MN. Lars Lyle Roth practices in Ely, MN. The NPI Number for Lars Lyle Roth is 1821107541 and holds a License No. 01263 (Minnesota).
The current practice location address for Lars Lyle Roth is 39 E Sheridan, Ely, MN and can be reached out via phone at 218-365-5770.
Location: 39 E Sheridan, Ely, MN, 55731
Provider Profile Details
NPI Number
1821107541
Provider Name
Lars Lyle Roth
Credential
Provider Entity Type
Individual
Gender
Male
Address
39 E Sheridan, Ely, MN, 55731
Phone Number
218-365-5770
Fax Number
Provider Enumeration Date
08/29/2006
Last Update Date
03/08/2024
Provider's Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 73220R0 | 01 | MN | BCBS OF MN |
| 908225500 | 01 | MN | MN HEALTH CARE PROGRAMS |
Provider Business Practice Location Address Details
Address
39 E Sheridan
City
State
Zip
55731
Phone Number
218-365-5770
Fax Number
Provider Business Mailing Address Details
Address
39 E Sheridan
City
State
Zip
55731
Phone Number
218-365-5770
Fax Number
Provider's Taxonomy Details 1
Type
Chiropractic Providers
Classification
Chiropractor
Speciality
-
Taxonomy
License No.
01263 (Minnesota)
Definition
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.
Badge
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