Provider Demographics
NPI:1780758466
Name:FOCHESATO, PETER JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOSEPH
Last Name:FOCHESATO
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 1:1600 ROOSEVELT AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-2646
Mailing Address - Country:US
Mailing Address - Phone:360-428-0304
Mailing Address - Fax:360-428-0968
Practice Address - Street 1:1600 ROOSEVELT AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2646
Practice Address - Country:US
Practice Address - Phone:360-428-0304
Practice Address - Fax:360-428-0968
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002227111N00000X
MI2301006668111N00000X
WI2305-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA49111OtherL&I NUMBER
WA8592FOOtherREGENCE RIDER NUMBER
T86918Medicare UPIN