Individual
DR. ANDREA LILLY DIEVENDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
2 CHELSEA PL, CLIFTON PARK, NY 12065-3227
(518) 373-6545
Mailing address
2 CHELSEA PL, CLIFTON PARK, NY 12065-3227
(518) 373-6545
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
X0108561
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2601222001
BSNENY
—
01
—
7016671
AETNA
—
01
—
NY23902
MVP
—
Enumeration date
12/06/2005
Last updated
08/25/2016
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