Provider Demographics
NPI:1285117200
Name:WHITELAW, ANDREW CHRISTENBERRY (LAC)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:CHRISTENBERRY
Last Name:WHITELAW
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 1:1322 ELECTRIC AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-3762
Mailing Address - Country:US
Mailing Address - Phone:310-766-0841
Mailing Address - Fax:
Practice Address - Street 1:3201 N SEPULVEDA BLVD STE A
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2463
Practice Address - Country:US
Practice Address - Phone:310-620-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-14
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18209171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist