Provider Demographics
NPI:1235311143
Name:LITTLE, CASEY G (DC)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:G
Last Name:LITTLE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1316 JACKIE RD SE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-6618
Mailing Address - Country:US
Mailing Address - Phone:505-891-3345
Mailing Address - Fax:505-891-3340
Practice Address - Street 1:1316 JACKIE RD SE
Practice Address - Street 2:SUITE 400
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-6618
Practice Address - Country:US
Practice Address - Phone:505-891-3345
Practice Address - Fax:505-891-3340
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM1716111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNMB2030Medicare PIN