Provider Demographics
NPI:1891587341
Name:LIGHT, MADISON ELIZABETH (DC)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:ELIZABETH
Last Name:LIGHT
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 1:528 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3602
Mailing Address - Country:US
Mailing Address - Phone:831-221-0281
Mailing Address - Fax:
Practice Address - Street 1:528 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3602
Practice Address - Country:US
Practice Address - Phone:831-221-0281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35271111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor