MEDICARE: TRAPP SPINAL CARE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3369	OK

General Provider Information

NPI Number	:	1912376609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAPP SPINAL CARE, PLLC

Provider Business Mailing Address
First Line	:	2017 S ELM PL
Second Line	:	SUITE 100
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-7034
Country	:	US
Telephone Number	:	918-449-9555
Fax Number	:	918-449-9559

Provider Business Practice Location Address
First Line	:	2017 S ELM PL
Second Line	:	SUITE 100
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-7034
Country	:	US
Telephone Number	:	918-449-9555
Fax Number	:	918-449-9559

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. CONRAD LOUIS TRAPP
Credential	:	DC
Telephone Number	:	918-449-9555

Provider Enumeration Date	:	09/23/2015
Last Update Date	:	09/23/2015

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