Provider Demographics
NPI:1922271527
Name:LATTIMER, BRIAN J (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
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 1:702 6TH AVE S STE 5
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-3568
Mailing Address - Country:US
Mailing Address - Phone:843-249-5433
Mailing Address - Fax:
Practice Address - Street 1:702 6TH AVE S STE 5
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3568
Practice Address - Country:US
Practice Address - Phone:843-249-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV725111N00000X
SC2396111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2203014000Medicaid
WV4045291Medicare PIN