Provider Demographics
NPI:1609366434
Name:LIGHT, STEVEN DANIEL (DC)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:DANIEL
Last Name:LIGHT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:31815 SOUTHFIELD RD
Mailing Address - Street 2:SUITE 17
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025
Mailing Address - Country:US
Mailing Address - Phone:248-792-9736
Mailing Address - Fax:248-593-3181
Practice Address - Street 1:31815 SOUTHFIELD RD
Practice Address - Street 2:SUITE 17
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025
Practice Address - Country:US
Practice Address - Phone:248-792-9736
Practice Address - Fax:248-593-3181
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI2301010634111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor