Healthcare Provider Details

I. General information

NPI: 1053465708
Provider Name (Legal Business Name): TERRY ANN PACE DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 EAST 2ND STREET
WESTFIELD WI
53964-0095
US

IV. Provider business mailing address

PO BOX 95
WESTFIELD WI
53964-0095
US

V. Phone/Fax

Practice location:
  • Phone: 608-296-2717
  • Fax: 608-296-2717
Mailing address:
  • Phone: 608-296-2717
  • Fax: 608-296-2717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2199012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: