Provider Demographics
NPI:1164544896
Name:BOHATIUK, ALEXANDER NICHOLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:NICHOLAS
Last Name:BOHATIUK
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 1:811 GOVERNORS PLACE
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701
Mailing Address - Country:US
Mailing Address - Phone:302-836-8361
Mailing Address - Fax:302-836-8163
Practice Address - Street 1:811 GOVERNORS PLACE
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701
Practice Address - Country:US
Practice Address - Phone:302-836-8361
Practice Address - Fax:302-836-8163
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF10000281111N00000X
PADC003923L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
4370293OtherAETNA
564171OtherBLUE CROSS
564171OtherAMERIHEALTH
0385484000OtherKEYSTONE
564171OtherAMERIHEALTH
U01445Medicare ID - Type Unspecified