Provider Demographics
NPI:1902258635
Name:SCHWANZ, TREVOR (DC)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:SCHWANZ
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 1:21119 NE 169TH ST
Mailing Address - Street 2:
Mailing Address - City:BRUSH PRAIRIE
Mailing Address - State:WA
Mailing Address - Zip Code:98606-9773
Mailing Address - Country:US
Mailing Address - Phone:360-931-0086
Mailing Address - Fax:
Practice Address - Street 1:21119 NE 169TH ST
Practice Address - Street 2:
Practice Address - City:BRUSH PRAIRIE
Practice Address - State:WA
Practice Address - Zip Code:98606-9773
Practice Address - Country:US
Practice Address - Phone:360-931-0086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 60664228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor