Provider Demographics
NPI:1578595732
Name:PACE, BRUCE BAXTER (DC)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:BAXTER
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 1:3201 19TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-1911
Mailing Address - Country:US
Mailing Address - Phone:503-357-4441
Mailing Address - Fax:503-359-7941
Practice Address - Street 1:3201 19TH AVE STE A
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-1911
Practice Address - Country:US
Practice Address - Phone:503-357-4441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR271373111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
105241Medicare ID - Type Unspecified