Provider Demographics
NPI:1073845525
Name:LATHAM, TIMOTHY RICHARD (DC MS LDN CSCS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:RICHARD
Last Name:LATHAM
Suffix:
Gender:M
Credentials:DC MS LDN CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 EDINBORO ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1302
Mailing Address - Country:US
Mailing Address - Phone:724-554-2795
Mailing Address - Fax:
Practice Address - Street 1:665 BOYLSTON ST STE 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-4825
Practice Address - Country:US
Practice Address - Phone:724-554-2795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3868133N00000X
MA3532111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No133N00000XDietary & Nutritional Service ProvidersNutritionist