Provider Demographics
NPI:1043028848
Name:LITTLE, TRENTON PERRY (DC)
Entity type:Individual
Prefix:DR
First Name:TRENTON
Middle Name:PERRY
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 1:4020 LAZY RIVER RANCH RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-3824
Mailing Address - Country:US
Mailing Address - Phone:903-517-8725
Mailing Address - Fax:
Practice Address - Street 1:4020 LAZY RIVER RANCH RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-3824
Practice Address - Country:US
Practice Address - Phone:903-517-8725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-25
Last Update Date:2024-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty