Provider Demographics
NPI:1568777951
Name:WRIGHT, LATISHA
Entity Type:Individual
Prefix:
First Name:LATISHA
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3154
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-3154
Mailing Address - Country:US
Mailing Address - Phone:919-909-5153
Mailing Address - Fax:919-462-0410
Practice Address - Street 1:3811 N ROXBORO ST
Practice Address - Street 2:STE A
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-5800
Practice Address - Country:US
Practice Address - Phone:919-797-0428
Practice Address - Fax:919-797-0448
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3938111N00000X
SC3459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor