Provider Demographics
NPI:1275742975
Name:LIGHT, DAVID JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JAMES
Last Name:LIGHT
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 1:111 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-3607
Mailing Address - Country:US
Mailing Address - Phone:724-437-9020
Mailing Address - Fax:724-437-0295
Practice Address - Street 1:111 E MAIN ST
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-3607
Practice Address - Country:US
Practice Address - Phone:724-437-9020
Practice Address - Fax:724-437-0295
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA4928L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1043386OtherWV WC VENDOR NUMBER
PA1619126Medicaid
PA351224OtherBCBS GROUP NUMBER
PA1539534OtherGATEWAY PROVIDER NUMBER
PA120316Medicare UPIN
PA351224OtherBCBS GROUP NUMBER