Provider Demographics
NPI:1053464883
Name:PESEAU, SCOTT WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:WILLIAM
Last Name:PESEAU
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 1:215 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-1327
Mailing Address - Country:US
Mailing Address - Phone:360-474-9900
Mailing Address - Fax:360-474-8064
Practice Address - Street 1:215 E 3RD ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-1327
Practice Address - Country:US
Practice Address - Phone:360-474-9900
Practice Address - Fax:360-474-8064
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002428111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA183353OtherLABOR & INDUSTRIES
WA8401762Medicaid
WAU01652Medicare UPIN
WAG8803238Medicare ID - Type Unspecified