Provider Demographics
NPI:1053401901
Name:PACE, COLLEEN (DC)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:
Last Name:PACE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3154 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?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001365111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA004222582Medicaid
CT350001167Medicare ID - Type Unspecified
CTU82505Medicare UPIN