Provider Demographics
NPI:1720035579
Name:TRAPP, WALTER C (DC)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:C
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 1:15938 SE DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-2059
Mailing Address - Country:US
Mailing Address - Phone:503-761-9648
Mailing Address - Fax:503-761-6876
Practice Address - Street 1:15938 SE DIVISION ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-2059
Practice Address - Country:US
Practice Address - Phone:503-761-9648
Practice Address - Fax:503-761-6876
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR271642111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR270157Medicaid
ORR000QGCJPMedicare ID - Type Unspecified
OR270157Medicaid