Healthcare Provider Details

I. General information

NPI: 1902807399
Provider Name (Legal Business Name): KARA K LITTLE DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 EASTERN BLVD SUITE 201
BALTIMORE MD
21221-3442
US

IV. Provider business mailing address

9601 PULASKI PARK DR SUITE 416
MIDDLE RIVER MD
21220-1409
US

V. Phone/Fax

Practice location:
  • Phone: 410-682-5500
  • Fax: 410-686-1178
Mailing address:
  • Phone: 410-933-5678
  • Fax: 410-933-1823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberS02060
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: