Provider Demographics
NPI:1629342803
Name:LITTLE FAMILY CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:LITTLE FAMILY CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:601-764-2331
Mailing Address - Street 1:P.O. BOX 51
Mailing Address - Street 2:
Mailing Address - City:BAY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39422-4808
Mailing Address - Country:US
Mailing Address - Phone:601-764-2331
Mailing Address - Fax:601-764-2376
Practice Address - Street 1:13 EAST 8TH AVENUE
Practice Address - Street 2:
Practice Address - City:BAY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39422-4808
Practice Address - Country:US
Practice Address - Phone:601-764-2331
Practice Address - Fax:601-764-2376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS962111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSU83435Medicare UPIN