Provider Demographics
NPI:1912144452
Name:PACHECO, SCOTT KEVIN (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:KEVIN
Last Name:PACHECO
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 1:18332 36TH AVE W APT B9
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-3842
Mailing Address - Country:US
Mailing Address - Phone:510-501-5774
Mailing Address - Fax:
Practice Address - Street 1:9528 STATE AVE STE B
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-2279
Practice Address - Country:US
Practice Address - Phone:360-659-6554
Practice Address - Fax:360-653-4882
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60927781111N00000X
CA30644111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor