Provider Demographics
NPI:1700547395
Name:CONROD, AUSTIN MICHAEL (DC, MS)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:MICHAEL
Last Name:CONROD
Suffix:
Gender:M
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 HIGHWAY N STE 108
Mailing Address - Street 2:
Mailing Address - City:COTTLEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63304-8031
Mailing Address - Country:US
Mailing Address - Phone:636-706-6171
Mailing Address - Fax:
Practice Address - Street 1:5055 HIGHWAY N STE 108
Practice Address - Street 2:
Practice Address - City:COTTLEVILLE
Practice Address - State:MO
Practice Address - Zip Code:63304-8031
Practice Address - Country:US
Practice Address - Phone:636-706-6171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021051074111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor