Organization
MOUNT VERNON CHIROPRACTIC, INC., P.S.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER JOSEPH FOCHESATO D.C. (PRESIDENT)
(360) 428-0304
Entity
Organization
Contact information
Practice address
1600 ROOSEVELT AVE, SUITE A, MOUNT VERNON, WA 98273-2646
(360) 428-0304
(360) 428-0968
Mailing address
1600 ROOSEVELT AVE, SUITE A, MOUNT VERNON, WA 98273-2646
(360) 428-0304
(360) 428-0968
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CH00002227
WA
111N00000X
Chiropractor
CH00034784
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
304854304854
PREMERA BLUE CROSS
WA
01
—
49111
LABOR AND INDUSTRIES
WA
01
—
8592FO
REGENCE BLUE SHIELD
WA
Enumeration date
09/26/2007
Last updated
10/22/2007
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