Provider Demographics
NPI:1306896741
Name:LITTLE, R GIL (DC)
Entity type:Individual
Prefix:DR
First Name:R
Middle Name:GIL
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 1:319 VANN DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-6032
Mailing Address - Country:US
Mailing Address - Phone:731-660-1234
Mailing Address - Fax:731-660-5667
Practice Address - Street 1:319 VANN DR
Practice Address - Street 2:SUITE D
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-6032
Practice Address - Country:US
Practice Address - Phone:731-660-1234
Practice Address - Fax:731-660-5667
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC620111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT74697Medicare UPIN
TN3674672Medicare ID - Type Unspecified