Provider Demographics
NPI:1902825474
Name:LITTLE, RONALD B (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:B
Last Name:LITTLE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3091 HIGHWAY 49 S
Mailing Address - Street 2:SUITE O
Mailing Address - City:FLORENCE
Mailing Address - State:MS
Mailing Address - Zip Code:39073-9452
Mailing Address - Country:US
Mailing Address - Phone:601-845-3114
Mailing Address - Fax:601-845-3114
Practice Address - Street 1:3091 HIGHWAY 49 S
Practice Address - Street 2:SUITE O
Practice Address - City:FLORENCE
Practice Address - State:MS
Practice Address - Zip Code:39073-9452
Practice Address - Country:US
Practice Address - Phone:601-845-3114
Practice Address - Fax:601-845-3114
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0972111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0012-00-84Medicaid