Provider Demographics
NPI:1679617856
Name:FOURNIER, ANDRE CHESTER (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:CHESTER
Last Name:FOURNIER
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 1:5201 S FOX TROT DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-1116
Mailing Address - Country:US
Mailing Address - Phone:520-331-2036
Mailing Address - Fax:
Practice Address - Street 1:4580 E GRANT RD
Practice Address - Street 2:SUITE 160
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2648
Practice Address - Country:US
Practice Address - Phone:520-326-2100
Practice Address - Fax:520-326-2110
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7265111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ943656Medicaid
AZ2Z3143OtherHEALTHNET PROV. # ID
AZ3949OtherAZ PHYSIOTHERAPY #
AZ646119OtherACN NETWORK PROV. #
AZAZ0442830OtherBCBS #
AZ1036605OtherASHN PROV. #
AZ7265OtherCHIROPRACTIC LICENSE #
AZ7265OtherCHIROPRACTIC LICENSE #
AZ109190Medicare ID - Type UnspecifiedMEDICARE #