Provider Demographics
NPI:1417554627
Name:GRAY, AUSTIN MONTGOMERY (DC)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:MONTGOMERY
Last Name:GRAY
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 1:4229 W FRONTAGE RD NW
Mailing Address - Street 2:STE 7
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901
Mailing Address - Country:US
Mailing Address - Phone:507-721-9438
Mailing Address - Fax:
Practice Address - Street 1:4229 WEST FRONTAGE RD NW
Practice Address - Street 2:STE 7
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901
Practice Address - Country:US
Practice Address - Phone:507-721-9438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6763111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor