Stacey Roth, DC

Primary specialty

Pediatric ChiropractorTaxonomy code 111NP0017X

License

3114 Issued in MN

Practice address

1906 30TH Ave S
Moorhead, MN 56560-5210

Phone

(218) 233-2517

NPI assigned

Apr 2, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Chiropractic

Education

Northwestern College of Chiropractic, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Roth Family Chiropractic IncGroup PAC ID 3274623863, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Roth Family Chiropractic Inc.

  • Chiropractor
  • Moorhead, MN
  • NPI 1104018373
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1333324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333324800000",
    "number": "1770849929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1906 30TH AVE S",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565605210",
            "telephone_number": "218-233-2517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1906 30TH AVE S",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565605210",
            "telephone_number": "218-233-2517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "STACEY",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-02",
        "last_updated": "2012-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NP0017X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Pediatric Chiropractor",
            "state": "MN",
            "license": "3114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rooted Counseling
• Drew Ross
• David P Rostad, DDS
• Roth Family Chiropractic Inc.
• Jason D Roth, DC
• Krista Rotondi
• Kendra M Routh
• Jodi Roy
• Samantha Rumbaut
• Madeline Rutherford

• Pediatric Chiropractor in Moorhead, MN
• Providers in Moorhead, MN by specialty
• Pediatric Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.