Provider Demographics
NPI:1588613202
Name:PACE, DAVID GEORGE, THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GEORGE, THOMAS
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 1:3717 SONG SPARROW DR.
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-1630
Mailing Address - Country:US
Mailing Address - Phone:919-744-5508
Mailing Address - Fax:919-484-4188
Practice Address - Street 1:3825 S ROXBORO ST
Practice Address - Street 2:SUITE 115
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-2799
Practice Address - Country:US
Practice Address - Phone:919-484-4141
Practice Address - Fax:919-484-4188
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085YWOtherBCBS PROVIDER NUMBER
NC018E9OtherBCBS GROUP NUMBER
NC5903539Medicaid
NC5903539Medicaid
NC085YWOtherBCBS PROVIDER NUMBER
NCV09397Medicare UPIN