Provider Demographics
NPI:1356511125
Name:DR. GARY J. LITLE, CHIROPRACTIC PHYSICIAN, P.C.
Entity Type:Organization
Organization Name:DR. GARY J. LITLE, CHIROPRACTIC PHYSICIAN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LITLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-266-4245
Mailing Address - Street 1:P.O. BOX 1230
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:MT
Mailing Address - Zip Code:59644
Mailing Address - Country:US
Mailing Address - Phone:406-266-4245
Mailing Address - Fax:406-587-6074
Practice Address - Street 1:101 B STREET
Practice Address - Street 2:SUITE B
Practice Address - City:TOWNSEND
Practice Address - State:MT
Practice Address - Zip Code:59644
Practice Address - Country:US
Practice Address - Phone:406-266-4245
Practice Address - Fax:406-587-6074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT567111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000004201Medicare PIN