Healthcare Provider Details

I. General information

NPI: 1497525695
Provider Name (Legal Business Name): AUSTIN PARKER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 PROFESSIONAL PKWY
TROY MO
63379-2822
US

IV. Provider business mailing address

1302 HEARTLAND VIEW CIR
WENTZVILLE MO
63385-2503
US

V. Phone/Fax

Practice location:
  • Phone: 636-356-5557
  • Fax:
Mailing address:
  • Phone: 407-221-2468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2023050826
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: