MEDICARE: LATISHA WRIGHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3938	NC
2	111N00000X	Chiropractor	3459	SC

General Provider Information

NPI Number	:	1568777951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATISHA WRIGHT

Provider Business Mailing Address
First Line	:	PO BOX 3154
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27519-3154
Country	:	US
Telephone Number	:	919-909-5153
Fax Number	:	919-462-0410

Provider Business Practice Location Address
First Line	:	3811 N ROXBORO ST
Second Line	:	STE A
City	:	DURHAM
State	:	NC
Zip	:	27704-5800
Country	:	US
Telephone Number	:	919-797-0428
Fax Number	:	919-797-0448

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2010
Last Update Date	:	10/19/2017

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Directions to “ LATISHA WRIGHT ” Practice Location

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