Provider Demographics
NPI:1043574528
Name:BAKOMENKO, CARL J (DC)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:J
Last Name:BAKOMENKO
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 1:1426 N CLAYTON ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-4006
Mailing Address - Country:US
Mailing Address - Phone:302-300-4242
Mailing Address - Fax:302-300-4241
Practice Address - Street 1:1426 N CLAYTON ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-4006
Practice Address - Country:US
Practice Address - Phone:302-300-4242
Practice Address - Fax:302-300-4241
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000833111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation