Provider Demographics
NPI:1760601629
Name:LITTLE CHIROPRACTIC,PC
Entity Type:Organization
Organization Name:LITTLE CHIROPRACTIC,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:GIL
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:731-660-1234
Mailing Address - Street 1:319 VANN DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-6032
Mailing Address - Country:US
Mailing Address - Phone:731-660-1234
Mailing Address - Fax:731-660-5667
Practice Address - Street 1:319 VANN DR
Practice Address - Street 2:SUITE D
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-6032
Practice Address - Country:US
Practice Address - Phone:731-660-1234
Practice Address - Fax:731-660-5667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC620111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT74697Medicare UPIN