Provider Demographics
NPI:1972835650
Name:LATHAM, LAURA E (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:E
Last Name:LATHAM
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 1:2 OAK HILL DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-1021
Mailing Address - Country:US
Mailing Address - Phone:724-208-5509
Mailing Address - Fax:
Practice Address - Street 1:2 OAK HILL DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1021
Practice Address - Country:US
Practice Address - Phone:724-208-5509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00604111N00000X
PADC010368111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA265375YDMTOtherMEDICARE ID NUMBER