Provider Demographics
NPI:1053465708
Name:PACE, TERRY ANN (DC)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:ANN
Last Name:PACE
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:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53964-0095
Mailing Address - Country:US
Mailing Address - Phone:608-296-2717
Mailing Address - Fax:608-296-2717
Practice Address - Street 1:128 EAST 2ND STREET
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:WI
Practice Address - Zip Code:53964-0095
Practice Address - Country:US
Practice Address - Phone:608-296-2717
Practice Address - Fax:608-296-2717
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2199012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
000135544Medicare ID - Type Unspecified