Provider Demographics
NPI:1598894313
Name:CONROD, MARK ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:CONROD
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 1:1802 DIVISION ST
Mailing Address - Street 2:SUITE211
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1182
Mailing Address - Country:US
Mailing Address - Phone:815-941-2225
Mailing Address - Fax:815-941-2785
Practice Address - Street 1:1802 DIVISION ST
Practice Address - Street 2:SUITE211
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1182
Practice Address - Country:US
Practice Address - Phone:815-941-2225
Practice Address - Fax:815-941-2785
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2008-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-006182111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK48991Medicare PIN
ILT39190Medicare UPIN