Provider Demographics
NPI:1134496078
Name:K. WAYNE LATIMER, D.C.,P.C.
Entity Type:Organization
Organization Name:K. WAYNE LATIMER, D.C.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:W
Authorized Official - Last Name:LATIMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-890-1662
Mailing Address - Street 1:1288 DOW ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-2413
Mailing Address - Country:US
Mailing Address - Phone:615-890-1662
Mailing Address - Fax:615-890-9475
Practice Address - Street 1:1288 DOW ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2413
Practice Address - Country:US
Practice Address - Phone:615-890-1662
Practice Address - Fax:615-890-9475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC00152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT74788Medicare UPIN
TN3671397Medicare PIN