MEDICARE: DR. KRYSTA LYNN LITTLE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	11990	TX
2	111N00000X	Chiropractor	5661	AZ

General Provider Information

NPI Number	:	1386690402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRYSTA LYNN LITTLE D.C.

Provider Business Mailing Address
First Line	:	PO BOX 650040
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75265-0040
Country	:	US
Telephone Number	:	817-391-0130
Fax Number	:	817-391-0136

Provider Business Practice Location Address
First Line	:	309 S. JUPITER
Second Line	:	100
City	:	ALLEN
State	:	TX
Zip	:	75002-3052
Country	:	US
Telephone Number	:	214-547-7234
Fax Number	:	214-547-7236

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	04/15/2015

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