Provider Demographics
NPI:1538144605
Name:SIMPSON, LATANYA C (DC)
Entity Type:Individual
Prefix:DR
First Name:LATANYA
Middle Name:C
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 MEDICAL PARK DR W
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-2705
Mailing Address - Country:US
Mailing Address - Phone:252-991-4290
Mailing Address - Fax:252-991-4291
Practice Address - Street 1:1704 MEDICAL PARK DR W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-2705
Practice Address - Country:US
Practice Address - Phone:252-991-4290
Practice Address - Fax:252-991-4291
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085NUMedicaid
NCA262OtherPTAN
NCU97029Medicare UPIN
NCNC1635A262Medicare PIN