Provider Demographics
NPI:1164595666
Name:PACE, THOMAS SNYDER (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:SNYDER
Last Name:PACE
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 1:2316 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-2450
Mailing Address - Country:US
Mailing Address - Phone:503-357-4441
Mailing Address - Fax:503-359-7941
Practice Address - Street 1:2316 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2450
Practice Address - Country:US
Practice Address - Phone:503-357-4441
Practice Address - Fax:503-359-7941
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273142111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR105581Medicare ID - Type Unspecified