MEDICARE: DR. SCOTT WILLIAM PESEAU DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH00002428	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	183353	OTHER	WA	LABOR & INDUSTRIES
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053464883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT WILLIAM PESEAU DC

Provider Business Mailing Address
First Line	:	215 E 3RD ST
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-1327
Country	:	US
Telephone Number	:	360-474-9900
Fax Number	:	360-474-8064

Provider Business Practice Location Address
First Line	:	215 E 3RD ST
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-1327
Country	:	US
Telephone Number	:	360-474-9900
Fax Number	:	360-474-8064

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. SCOTT WILLIAM PESEAU DC” Practice Location

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