Provider Demographics
NPI:1073863940
Name:HEROLD, ANDREA LEE (DC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEE
Last Name:HEROLD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:NY
Mailing Address - Zip Code:14006-9281
Mailing Address - Country:US
Mailing Address - Phone:716-549-1999
Mailing Address - Fax:716-549-1990
Practice Address - Street 1:905 LAKE ST
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:NY
Practice Address - Zip Code:14006
Practice Address - Country:US
Practice Address - Phone:716-998-6980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012238-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor