Healthcare Provider Details

I. General information

NPI: 1902825474
Provider Name (Legal Business Name): RONALD B. LITTLE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3091 HIGHWAY 49 S SUITE O
FLORENCE MS
39073-9452
US

IV. Provider business mailing address

3091 HIGHWAY 49 S SUITE O
FLORENCE MS
39073-9452
US

V. Phone/Fax

Practice location:
  • Phone: 601-845-3114
  • Fax: 601-845-3114
Mailing address:
  • Phone: 601-845-3114
  • Fax: 601-845-3114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0972
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: