Provider Demographics
NPI:1689785909
Name:WHITELAW, STEPHEN HOMER (DC)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:HOMER
Last Name:WHITELAW
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 1:9515 SOQUEL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-4136
Mailing Address - Country:US
Mailing Address - Phone:831-688-7077
Mailing Address - Fax:831-688-7385
Practice Address - Street 1:9030 SOQUEL DRIVE
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-3900
Practice Address - Country:US
Practice Address - Phone:831-688-7077
Practice Address - Fax:831-688-7385
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19646111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U67530Medicare UPIN
CADC0196460Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER