Healthcare Provider Details

I. General information

NPI: 1285117200
Provider Name (Legal Business Name): ANDREW CHRISTENBERRY WHITELAW LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 N SEPULVEDA BLVD STE A
MANHATTAN BEACH CA
90266-2463
US

IV. Provider business mailing address

1322 ELECTRIC AVE APT 2
VENICE CA
90291-3762
US

V. Phone/Fax

Practice location:
  • Phone: 310-620-9090
  • Fax:
Mailing address:
  • Phone: 310-766-0841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number18209
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: