Provider Demographics
NPI:1730575770
Name:LITTLE, ALICIA (DC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:LITTLE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 RALSTON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-5313
Mailing Address - Country:US
Mailing Address - Phone:419-782-2272
Mailing Address - Fax:419-785-4066
Practice Address - Street 1:1018 RALSTON AVE STE 102
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-5313
Practice Address - Country:US
Practice Address - Phone:419-782-2272
Practice Address - Fax:419-785-4066
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-07
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH373230OtherMEDICARE PTAN
OH0156020Medicaid