Provider Demographics
NPI:1386690402
Name:LITTLE, KRYSTA LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:KRYSTA
Middle Name:LYNN
Last Name:LITTLE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 650040
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0040
Mailing Address - Country:US
Mailing Address - Phone:817-391-0130
Mailing Address - Fax:817-391-0136
Practice Address - Street 1:309 S. JUPITER
Practice Address - Street 2:100
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-3052
Practice Address - Country:US
Practice Address - Phone:214-547-7234
Practice Address - Fax:214-547-7236
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11990111N00000X
AZ5661111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU67373Medicare UPIN