Provider Demographics
NPI:1396990305
Name:COMPREHENSIVE SPINE CARE, LLC
Entity type:Organization
Organization Name:COMPREHENSIVE SPINE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GANESH
Authorized Official - Middle Name:R
Authorized Official - Last Name:BALU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-312-3809
Mailing Address - Street 1:240 BEISER BLVD
Mailing Address - Street 2:SUITE 202A
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-8208
Mailing Address - Country:US
Mailing Address - Phone:302-734-0300
Mailing Address - Fax:302-734-9300
Practice Address - Street 1:240 BEISER BLVD
Practice Address - Street 2:SUITE 202A
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-8208
Practice Address - Country:US
Practice Address - Phone:302-734-0300
Practice Address - Fax:302-734-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC-100054672081P2900X
DEF1-0000706111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty