Provider Demographics
NPI:1487931242
Name:BRUCE BAXTER PACE
Entity type:Organization
Organization Name:BRUCE BAXTER PACE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:B
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-357-4441
Mailing Address - Street 1:3201 19TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-1911
Mailing Address - Country:US
Mailing Address - Phone:503-357-4441
Mailing Address - Fax:503-359-7941
Practice Address - Street 1:3201 19TH AVE
Practice Address - Street 2:STE A
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-1911
Practice Address - Country:US
Practice Address - Phone:503-357-4441
Practice Address - Fax:503-359-7941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty