Healthcare Provider Details

I. General information

NPI: 1194934083
Provider Name (Legal Business Name): BEAR CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 GOVERNORS PL
BEAR DE
19701-3046
US

IV. Provider business mailing address

811 GOVERNORS PL
BEAR DE
19701-3046
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 NumberF1-0000281
License Number StateDE

VIII. Authorized Official

Name: DR. ALEXANDER BOHATIUK
Title or Position: OWNER
Credential: D.C.
Phone: 302-836-8361