Provider Demographics
NPI:1952454951
Name:HENDERSON, ANDREW DAMRELL (L AC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:DAMRELL
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 14TH ST # 227
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-6321
Mailing Address - Country:US
Mailing Address - Phone:303-449-2600
Mailing Address - Fax:303-440-7004
Practice Address - Street 1:1136 ALPINE AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3405
Practice Address - Country:US
Practice Address - Phone:303-449-2600
Practice Address - Fax:303-449-2600
Is Sole Proprietor?:No
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO244171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist