Provider Demographics
NPI:1003031006
Name:PACE CHIROPRACTIC WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:PACE CHIROPRACTIC WELLNESS CENTER, LLC
Other - Org Name:MT. CARMEL CHIROPRACTIC AND ACCUPUNCTURE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-281-9635
Mailing Address - Street 1:3154 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-2321
Mailing Address - Country:US
Mailing Address - Phone:203-281-9635
Mailing Address - Fax:203-281-9650
Practice Address - Street 1:3154 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-2321
Practice Address - Country:US
Practice Address - Phone:203-281-9635
Practice Address - Fax:203-281-9650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001366111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004222582Medicaid
CT001366OtherLICENSE
CT1053401901OtherNPI
CT004208189Medicaid
CT1831289776OtherNPI
CT001365OtherLICENSE
CT004222582Medicaid
CT001365OtherLICENSE
CT1053401901OtherNPI
CT004208189Medicaid