Provider Demographics
NPI:1790914125
Name:DILENA, AMY (DC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:DILENA
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 1:1179 N MCDOWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-6559
Mailing Address - Country:US
Mailing Address - Phone:707-559-7500
Mailing Address - Fax:707-559-7620
Practice Address - Street 1:129 KELLER ST
Practice Address - Street 2:SUITE C
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2314
Practice Address - Country:US
Practice Address - Phone:707-781-9549
Practice Address - Fax:707-284-1013
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0289770111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor