Provider Demographics
NPI:1932404712
Name:TRAPASSO, JACK (DC)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:TRAPASSO
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 1:1821 WILSHIRE BLVD STE 610
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5671
Mailing Address - Country:US
Mailing Address - Phone:310-453-4700
Mailing Address - Fax:310-453-8056
Practice Address - Street 1:1601 CLOVERFIELD BLVD STE 1050N
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-4171
Practice Address - Country:US
Practice Address - Phone:310-453-4700
Practice Address - Fax:310-453-8056
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30817111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician