Provider Demographics
NPI:1831638675
Name:MARUM, TREVOR JOHN (DC)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:JOHN
Last Name:MARUM
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 1:4444 LACEY BLVD SE STE E
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-5730
Mailing Address - Country:US
Mailing Address - Phone:360-999-9848
Mailing Address - Fax:
Practice Address - Street 1:4444 LACEY BLVD SE STE E
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5730
Practice Address - Country:US
Practice Address - Phone:360-999-9848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60884033111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2134869Medicaid