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General NPI Number Information
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NPI Number | 1811262728
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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 | 03/12/2012
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Last Update Date | 03/12/2012
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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 | 62095-1898
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Country | US
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Telephone | 618-259-3321
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 649
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City | WOOD RIVER
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State | IL
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Zip | 62095-0649
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Country | US
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Telephone | 618-259-3321
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. 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 | 038009545
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License Number State | IL
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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 | 038004303
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 36048379
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 70004750
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License Number State | IL
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Taxonomy #5
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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 | 36048379
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License Number State | IL
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