# PHYSICAL MEDICINE CLINIC OF GRANITE CITY LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992039747
- **Authorized official:** DR. BRIDGET BRASFIELD D.C. (OWNER/CHIROPRACTOR)
- **Authorized official phone:** (618) 877-4000

## Contact information

- **Practice address:** 2861 MADISON AVE, GRANITE CITY, IL 62040-3614
- **Practice address phone:** (618) 877-4000
- **Practice address fax:** (618) 877-0874
- **Mailing address:** 2861 MADISON AVE, GRANITE CITY, IL 62040-3614
- **Mailing address phone:** (618) 877-4000
- **Mailing address fax:** (618) 877-0874

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | 038009646 | IL | — |
| 363LA2200X | Adult Health Nurse Practitioner | 209007631 | IL | Yes |

## Other

- **Enumeration date:** 09/28/2009
- **Last updated:** 10/15/2013