Provider Demographics
NPI:1033142690
Name:FOURNIER, JAESON T (DC, MPH)
Entity Type:Individual
Prefix:DR
First Name:JAESON
Middle Name:T
Last Name:FOURNIER
Suffix:
Gender:M
Credentials:DC, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 KRAMER LN STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-4196
Mailing Address - Country:US
Mailing Address - Phone:512-595-4337
Mailing Address - Fax:
Practice Address - Street 1:2115 KRAMER LN STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-4196
Practice Address - Country:US
Practice Address - Phone:512-595-4337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13739111N00000X
MN5405111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor