Provider Demographics
NPI:1093850349
Name:SEVIGNY, TREVOR DWYER (LAC)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:DWYER
Last Name:SEVIGNY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9039 GARDNER LOOP ROAD
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-968-6478
Mailing Address - Fax:
Practice Address - Street 1:90390 GARDNER LOOP ROAD
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-2112
Practice Address - Country:US
Practice Address - Phone:253-968-6478
Practice Address - Fax:206-624-0766
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002460171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist