Provider Demographics
NPI:1508980293
Name:KENNETH W TRAPP DC INC
Entity Type:Organization
Organization Name:KENNETH W TRAPP DC INC
Other - Org Name:CHIROPRACTIC CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:TRAPP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-493-2000
Mailing Address - Street 1:5600 PACIFIC AVENUE SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1258
Mailing Address - Country:US
Mailing Address - Phone:360-493-2000
Mailing Address - Fax:360-493-2437
Practice Address - Street 1:5600 PACIFIC AVE SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1258
Practice Address - Country:US
Practice Address - Phone:360-493-2000
Practice Address - Fax:360-493-2437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002178111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty