Healthcare Provider Details

I. General information

NPI: 1871660852
Provider Name (Legal Business Name): EMMANUEL RIDGE CHIROPRACTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2073 HIGHWAY 49 S SUITE C
FLORENCE MS
39073-9422
US

IV. Provider business mailing address

2073 HIGHWAY 49 S SUITE C
FLORENCE MS
39073-9422
US

V. Phone/Fax

Practice location:
  • Phone: 601-709-3304
  • Fax: 601-709-3308
Mailing address:
  • Phone: 601-709-3304
  • Fax: 601-709-3308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number0972
License Number StateMS

VIII. Authorized Official

Name: DR. RONALD B LITTLE
Title or Position: CHIROPRACTOR
Credential: D.C
Phone: 601-709-3304