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General NPI Number Information
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NPI Number | 1871660852
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Entity Type | Organization
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Legal Business Name | EMMANUEL RIDGE CHIROPRACTIC SERVICES
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2073 HIGHWAY 49 S SUITE C
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City | FLORENCE
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State | MS
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Zip | 39073-9422
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Country | US
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Telephone | 601-709-3304
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Fax | 601-709-3308
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Provider Business Mailing Address
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Address Line | 2073 HIGHWAY 49 S SUITE C
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City | FLORENCE
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State | MS
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Zip | 39073-9422
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Country | US
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Telephone | 601-709-3304
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Fax | 601-709-3308
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. RONALD B LITTLE
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Credential | D.C
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Telephone | 601-709-3304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0200X
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Taxonomy Name | Radiology Chiropractor
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License Number | 0972
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License Number State | MS
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