Provider Demographics
NPI:1487786273
Name:BOHL, TYSON R (DC)
Entity type:Individual
Prefix:DR
First Name:TYSON
Middle Name:R
Last Name:BOHL
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 1:120 OLD CAMDEN RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CAMDEN
Mailing Address - State:DE
Mailing Address - Zip Code:19934-5523
Mailing Address - Country:US
Mailing Address - Phone:302-531-1900
Mailing Address - Fax:302-531-1901
Practice Address - Street 1:120 OLD CAMDEN RD
Practice Address - Street 2:SUITE C
Practice Address - City:CAMDEN
Practice Address - State:DE
Practice Address - Zip Code:19934-5523
Practice Address - Country:US
Practice Address - Phone:302-531-1900
Practice Address - Fax:302-531-1901
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE510340396OtherBLUE CROSS BLUE SHIELD
DE510411125OtherCOVENTRY, PIP, OTHER
DE510340396OtherBLUE CROSS BLUE SHIELD