Provider Demographics
NPI:1679615678
Name:LATIMER, WAYNE MARK
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:MARK
Last Name:LATIMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 N MISSION ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2049
Mailing Address - Country:US
Mailing Address - Phone:509-884-4357
Mailing Address - Fax:509-888-4601
Practice Address - Street 1:739 SOUTH MISSION ST.
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801
Practice Address - Country:US
Practice Address - Phone:509-665-7208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3606111NS0005X
WACH00003031111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0159778OtherWA ST. LABOR AND INDUSTRY
AB28793Medicare ID - Type Unspecified
WAU56752Medicare UPIN