Provider Demographics
NPI:1003788290
Name:BONNER, JASMINE (DC, MS, BSES)
Entity type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:
Last Name:BONNER
Suffix:
Gender:F
Credentials:DC, MS, BSES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9009 N FM 620 RD APT 1312
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-4216
Mailing Address - Country:US
Mailing Address - Phone:512-270-0375
Mailing Address - Fax:
Practice Address - Street 1:4012 MARATHON BLVD STE 5
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3718
Practice Address - Country:US
Practice Address - Phone:512-270-0375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16293111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty