Provider Demographics
NPI:1205948577
Name:BRASFIELD, BRIDGET ELLEN (DC DR OF CHIRO MED)
Entity type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:ELLEN
Last Name:BRASFIELD
Suffix:
Gender:F
Credentials:DC DR OF CHIRO MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2861 MADISON AVENUE
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-3614
Mailing Address - Country:US
Mailing Address - Phone:618-877-4000
Mailing Address - Fax:618-877-0874
Practice Address - Street 1:2861 MADISON AVENUE
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-3614
Practice Address - Country:US
Practice Address - Phone:618-877-4000
Practice Address - Fax:618-877-0874
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0006032042OtherBCBS
IL2177820538Medicaid
IL203829Medicare ID - Type Unspecified
IL0006032042OtherBCBS