Healthcare Provider Details

I. General information

NPI: 1396990305
Provider Name (Legal Business Name): COMPREHENSIVE SPINE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 11/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 BEISER BLVD SUITE 202A
DOVER DE
19904-8208
US

IV. Provider business mailing address

240 BEISER BLVD SUITE 202A
DOVER DE
19904-8208
US

V. Phone/Fax

Practice location:
  • Phone: 302-734-0300
  • Fax: 302-734-9300
Mailing address:
  • Phone: 302-734-0300
  • Fax: 302-734-9300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberC-10005467
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberF1-0000706
License Number StateDE

VIII. Authorized Official

Name: DR. GANESH R BALU
Title or Position: PRESIDENT
Credential: MD
Phone: 302-312-3809