Provider Demographics
NPI:1528024296
Name:TRAPP, KENNETH WAYNE (DC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:WAYNE
Last Name:TRAPP
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 1:5600 PACIFIC AVE 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002178111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WATR0129OtherREGENCE BLUE SHIELD
WA2010791Medicaid
WATR0129OtherREGENCE BLUE SHIELD