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 1:25060 AVENUE STANFORD STE 290
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-0984
Mailing Address - Country:US
Mailing Address - Phone:661-491-1900
Mailing Address - Fax:
Practice Address - Street 1:25060 AVENUE STANFORD STE 290
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-0984
Practice Address - Country:US
Practice Address - Phone:661-491-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30817111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NR0400XChiropractic ProvidersChiropractorRehabilitation