Provider Demographics
NPI:1194934083
Name:BEAR CHIROPRACTIC INC.
Entity type:Organization
Organization Name:BEAR CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHATIUK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-836-8361
Mailing Address - Street 1:811 GOVERNORS PL
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-3046
Mailing Address - Country:US
Mailing Address - Phone:302-836-8361
Mailing Address - Fax:302-836-8163
Practice Address - Street 1:811 GOVERNORS PL
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-3046
Practice Address - Country:US
Practice Address - Phone:302-836-8361
Practice Address - Fax:302-836-8163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000281111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEU01445Medicare UPIN
564171Medicare PIN