Provider Demographics
NPI:1376875203
Name:FOURNIER, MARIA (DC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:109 WOODMONT DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508
Mailing Address - Country:US
Mailing Address - Phone:979-255-9822
Mailing Address - Fax:
Practice Address - Street 1:2201 KALISTE SALOOM
Practice Address - Street 2:202
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508
Practice Address - Country:US
Practice Address - Phone:337-504-5458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1542111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor