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General NPI Number Information
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NPI Number | 1396990305
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE SPINE CARE, LLC
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Dates
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Enumeration Date | 11/19/2008
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Last Update Date | 11/19/2008
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Provider Practice Location Address
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Address Line | 240 BEISER BLVD SUITE 202A
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City | DOVER
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State | DE
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Zip | 19904-8208
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Country | US
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Telephone | 302-734-0300
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Fax | 302-734-9300
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Provider Business Mailing Address
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Address Line | 240 BEISER BLVD SUITE 202A
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City | DOVER
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State | DE
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Zip | 19904-8208
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Country | US
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Telephone | 302-734-0300
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Fax | 302-734-9300
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GANESH R BALU
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Credential | MD
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Telephone | 302-312-3809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | C-10005467
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | F1-0000706
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License Number State | DE
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