Provider Demographics
NPI:1851396527
Name:LATTIMER, PAUL (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:LATTIMER
Suffix:
Gender:M
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:PO BOX 414
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-0414
Mailing Address - Country:US
Mailing Address - Phone:304-269-4843
Mailing Address - Fax:304-269-3522
Practice Address - Street 1:18 GARTON PLZ
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-2129
Practice Address - Country:US
Practice Address - Phone:304-269-4843
Practice Address - Fax:304-269-3522
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV160111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0131670000Medicaid
WV0131670000Medicaid
WVLA0394232Medicare ID - Type Unspecified