Provider Demographics
NPI:1245378660
Name:PACE CHIROPRACTIC OFFICE SC
Entity Type:Organization
Organization Name:PACE CHIROPRACTIC OFFICE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-296-2717
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:608-296-2643
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:608-296-2643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI219912111N00000X
WI304012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty