NPIMap

Organization Active NPI

Mount Vernon Chiropractic, Inc., P.S.

  • Chiropractor
  • Mount Vernon, WA
National Provider Identifier
1932396652
Registry record updated Oct 22, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH00002227 Issued in WA
Legal business name
MOUNT VERNON CHIROPRACTIC, INC., P.S.
Practice address
1600 Roosevelt Ave
Suite a
Mount Vernon, WA 98273-2646
Phone
(360) 428-0304
Fax
(360) 428-0968
NPI assigned
Sep 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Peter Joseph Fochesato, D.C.NPI 1780758466
Title
President
Phone
(360) 428-0304

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X CH00002227 WA Primary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X CH00034784 WA

Addresses

Primary practice location

1600 Roosevelt Ave
Suite a
Mount Vernon, WA 98273-2646

Mailing address

1600 Roosevelt Ave
Suite a
Mount Vernon, WA 98273-2646
Phone (360) 428-0304

Other identifiers 3

IdentifierTypeStateIssuer
49111OtherWALABOR AND INDUSTRIES
304854304854OtherWAPREMERA BLUE CROSS
8592FOOtherWAREGENCE BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050218000331 WA Part B Supplier - Clinic/Group Practice 6608828546 Receives reassigned benefits from 1 practitioner
Practice locations: Mount Vernon, WA

National Provider Directory

National Provider Directory

Locations

1725 Continental Pl
Ste A
Mount Vernon, WA 98273
Phone (360) 428-0304

1600 Roosevelt Ave
Ste A
Mount Vernon, WA 98273
Phone (360) 428-0304

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193011200000",
    "number": "1932396652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 ROOSEVELT AVE",
            "address_2": "SUITE A",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982732646",
            "telephone_number": "360-428-0304",
            "fax_number": "360-428-0968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 ROOSEVELT AVE",
            "address_2": "SUITE A",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982732646",
            "telephone_number": "360-428-0304",
            "fax_number": "360-428-0968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNT VERNON CHIROPRACTIC, INC., P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-26",
        "last_updated": "2007-10-22",
        "status": "A",
        "authorized_official_last_name": "FOCHESATO",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "360-428-0304",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00002227",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00034784",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES",
            "identifier": "49111",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMERA BLUE CROSS",
            "identifier": "304854304854",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "8592FO",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.