Healthcare Provider Details

I. General information

NPI: 1396435079
Provider Name (Legal Business Name): JORDAN ALEXANDER LITTLE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5810 BAKER RD STE 100
MINNETONKA MN
55345-5941
US

IV. Provider business mailing address

17532 454TH AVE
WATERTOWN SD
57201-7693
US

V. Phone/Fax

Practice location:
  • Phone: 612-324-6338
  • Fax: 612-416-0053
Mailing address:
  • Phone: 605-520-9225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number82264
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number5101028872
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: