Provider Demographics
NPI:1295875805
Name:DR. GARY J. LITLE, CHIROPRACTIC PHYSICIAN, P.C.
Entity type:Organization
Organization Name:DR. GARY J. LITLE, CHIROPRACTIC PHYSICIAN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LITLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-587-0711
Mailing Address - Street 1:2245 W KOCH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-4010
Mailing Address - Country:US
Mailing Address - Phone:406-587-0711
Mailing Address - Fax:406-587-6074
Practice Address - Street 1:2245 W KOCH ST
Practice Address - Street 2:SUITE A
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-4010
Practice Address - Country:US
Practice Address - Phone:406-587-0711
Practice Address - Fax:406-587-6074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT567111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000004201Medicare PIN