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General NPI Number Information
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NPI Number | 1063470524
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Entity Type | Organization
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Legal Business Name | JERSEYVILLE PAIN MANAGEMENT CENTER, S.C.
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 01/22/2014
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Provider Practice Location Address
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Address Line | 1702 VAUGHN RD
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City | WOOD RIVER
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State | IL
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Zip | 62095
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Country | US
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Telephone | 618-259-3321
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Fax | 618-259-3324
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Provider Business Mailing Address
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Address Line | P.O. BOX 649
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City | WOOD RIVER
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State | IL
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Zip | 62095
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Country | US
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Telephone | 618-259-3321
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Fax | 618-259-3324
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Authorized Official
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Title or Position | OWNER
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Name | MR. JAMES A BRIGGS
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Credential | D.C.
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Telephone | 618-259-3321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 042-618378
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License Number State | IL
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