Provider Demographics
NPI:1962596874
Name:LATIMER, KENNETH WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:WAYNE
Last Name:LATIMER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:K.
Other - Middle Name:WAYNE
Other - Last Name:LATIMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1288 DOW ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-2413
Mailing Address - Country:US
Mailing Address - Phone:615-890-1662
Mailing Address - Fax:615-890-9475
Practice Address - Street 1:1288 DOW ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2413
Practice Address - Country:US
Practice Address - Phone:615-890-1662
Practice Address - Fax:615-890-9475
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC 00152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10835037OtherCAQH
TN2007913OtherBCBSTN
TNT74788Medicare UPIN
TN10835037OtherCAQH