JERSEYVILLE PAIN MANAGEMENT CENTER S.C. NPI 1063470524

NPI Information

NPI: 1063470524
Provider Name: JERSEYVILLE PAIN MANAGEMENT CENTER, S.C.
Classification: Chiropractor - 111N00000X
Entity Type: Organization
Address:
1702 VAUGHN RD
WOOD RIVER, IL
ZIP 62095
Phone: (618) 259-3321
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JERSEYVILLE PAIN MANAGEMENT CENTER, S.C. is a chiropractor in Wood River, IL. The provider is a provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. JERSEYVILLE PAIN MANAGEMENT CENTER, S.C. NPI is 1063470524. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1702 VAUGHN RD
WOOD RIVER, IL
ZIP 62095
Phone: (618) 259-3321
Fax: (618) 259-3324

The provider's authorized official is James A Briggs .
The authorized official title is Owner and has the following contact phone number (618) 259-3321.

The enumeration date for this NPI number is 5/3/2006 and was last updated on 1/22/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	111N00000X	Chiropractor		042-618378	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	5933000001	OTHER	ILLINOIS	MEDICARE DME
2	5933000001	MEDICARE PIN	ILLINOIS
3	U89003	MEDICARE UPIN	ILLINOIS
4	5933000001	MEDICARE NSC	ILLINOIS
5	210609	MEDICARE PIN	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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