MEDICARE: PAUL LATTIMER DC

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	160	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851396527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL LATTIMER DC

Provider Business Mailing Address
First Line	:	PO BOX 414
Second Line	:
City	:	WESTON
State	:	WV
Zip	:	26452-0414
Country	:	US
Telephone Number	:	304-269-4843
Fax Number	:	304-269-3522

Provider Business Practice Location Address
First Line	:	18 GARTON PLZ
Second Line	:
City	:	WESTON
State	:	WV
Zip	:	26452-2129
Country	:	US
Telephone Number	:	304-269-4843
Fax Number	:	304-269-3522

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	07/08/2007

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Directions to “ PAUL LATTIMER DC” Practice Location

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