Provider Demographics
NPI:1568635365
Name:DECHTER, STEPHEN M (DO)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:M
Last Name:DECHTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:MR
Other - First Name:STEVE
Other - Middle Name:M
Other - Last Name:DECHTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:711 S AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-5665
Mailing Address - Country:US
Mailing Address - Phone:509-586-2828
Mailing Address - Fax:509-586-2525
Practice Address - Street 1:9915 SANDIFUR PKWY STE B
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-8941
Practice Address - Country:US
Practice Address - Phone:509-586-2828
Practice Address - Fax:509-586-2525
Is Sole Proprietor?:No
Enumeration Date:2008-04-12
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO1611152081P2900X
CA20A120832081P2900X
390200000X
WAOP603289842081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA413675OtherL&I
WA2029386Medicaid
WAG8919701Medicare PIN