Provider Demographics
NPI:1831289776
Name:PACE, MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:PACE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:COLLEEN
Other - Middle Name:VERONICA
Other - Last Name:PACE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:3154 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-2321
Mailing Address - Country:US
Mailing Address - Phone:203-281-9635
Mailing Address - Fax:203-281-9650
Practice Address - Street 1:3154 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-2321
Practice Address - Country:US
Practice Address - Phone:203-281-9635
Practice Address - Fax:203-281-9650
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001366111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004208189Medicaid
CTU82107Medicare UPIN
CT350001167Medicare ID - Type Unspecified
CT004208189Medicaid