Provider Demographics
NPI:1336256791
Name:PACE, KENNETH DEAN (DC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:DEAN
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 1:3320 HESSMER AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-4727
Mailing Address - Country:US
Mailing Address - Phone:504-837-9300
Mailing Address - Fax:504-833-7222
Practice Address - Street 1:3320 HESSMER AVE
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-4727
Practice Address - Country:US
Practice Address - Phone:504-837-9300
Practice Address - Fax:504-833-7222
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA542111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1936545Medicaid
LA59114Medicare ID - Type Unspecified
LA1936545Medicaid