Healthcare Provider Details

I. General information

NPI: 1164544896
Provider Name (Legal Business Name): ALEXANDER NICHOLAS BOHATIUK DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 GOVERNORS PLACE
BEAR DE
19701
US

IV. Provider business mailing address

811 GOVERNORS PLACE
BEAR DE
19701
US

V. Phone/Fax

Practice location:
  • Phone: 302-836-8361
  • Fax: 302-836-8163
Mailing address:
  • Phone: 302-836-8361
  • Fax: 302-836-8163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberF10000281
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC003923L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: