Provider Demographics
NPI:1720278559
Name:LITTLETON CHIROPRACTIC CLINIC LLC
Entity type:Organization
Organization Name:LITTLETON CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANEY
Authorized Official - Middle Name:YAJUAN
Authorized Official - Last Name:LITTLETON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-997-4460
Mailing Address - Street 1:8420 DELMAR BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2170
Mailing Address - Country:US
Mailing Address - Phone:314-997-4460
Mailing Address - Fax:314-997-2306
Practice Address - Street 1:8420 DELMAR BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2170
Practice Address - Country:US
Practice Address - Phone:314-997-4460
Practice Address - Fax:314-997-2306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004021551111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000025960OtherMEDICARE PROVIDER NUMBER
MOM0459OtherMEDICARE SUBMITTER I.D. N
MO000025960OtherMEDICARE PROVIDER NUMBER