Organization
CORVALLIS PAIN AND SPINE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARL C BALOG M.D. (SECRETARY)
(503) 887-2209
Entity
Organization
Contact information
Practice address
2364 MAIN ST STE A, PHILOMATH, OR 97370-9361
(541) 929-2040
(541) 929-2170
Mailing address
2364 MAIN ST STE A, PHILOMATH, OR 97370-9361
(541) 929-2040
(541) 929-2170
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
74062
—
OR
01
—
831633001
BCBS
OR
Enumeration date
04/12/2011
Last updated
04/14/2011
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