Provider Demographics
NPI:1235454455
Name:SALEM BRAIN & SPINE, LLC
Entity Type:Organization
Organization Name:SALEM BRAIN & SPINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGDALENA
Authorized Official - Middle Name:JANINA
Authorized Official - Last Name:BANASIAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-990-6398
Mailing Address - Street 1:700 BELLEVUE ST SE
Mailing Address - Street 2:SUITE 245
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3819
Mailing Address - Country:US
Mailing Address - Phone:503-990-6398
Mailing Address - Fax:503-990-6399
Practice Address - Street 1:700 BELLEVUE ST SE
Practice Address - Street 2:SUITE 245
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3819
Practice Address - Country:US
Practice Address - Phone:503-990-6398
Practice Address - Fax:503-990-6399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD 150631261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500626535Medicaid
ORR156125Medicare PIN