Provider Demographics
NPI:1700021565
Name:BOCHARNIKOV, VIKTOR VLADIMIR (CMT)
Entity Type:Individual
Prefix:MR
First Name:VIKTOR
Middle Name:VLADIMIR
Last Name:BOCHARNIKOV
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 S PICKETT ST STE 204
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-7206
Mailing Address - Country:US
Mailing Address - Phone:705-461-8142
Mailing Address - Fax:
Practice Address - Street 1:50 S PICKETT ST STE 204
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-7206
Practice Address - Country:US
Practice Address - Phone:703-461-8142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019000221225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist