Healthcare Provider Details

I. General information

NPI: 1235311143
Provider Name (Legal Business Name): CASEY G LITTLE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 JACKIE RD SE SUITE 400
RIO RANCHO NM
87124-6618
US

IV. Provider business mailing address

1316 JACKIE RD SE SUITE 400
RIO RANCHO NM
87124-6618
US

V. Phone/Fax

Practice location:
  • Phone: 505-891-3345
  • Fax: 505-891-3340
Mailing address:
  • Phone: 505-891-3345
  • Fax: 505-891-3340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number1716
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: