Provider Demographics
NPI:1093289175
Name:HOLZWORTH, MADISON REBECCA (DC)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:REBECCA
Last Name:HOLZWORTH
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 1:1471 HANCHETT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2509
Mailing Address - Country:US
Mailing Address - Phone:408-489-5661
Mailing Address - Fax:
Practice Address - Street 1:260 S SUNNYVALE AVE STE 2
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-6273
Practice Address - Country:US
Practice Address - Phone:408-489-5661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34394111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor