Charles Blaine Illingworth IV, DIPL.AC., L.AC.

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

AK001285 Issued in PA

Practice address

601 E Main St
Lansdale, PA 19446-2947

Phone

(610) 724-3284

NPI assigned

Dec 19, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1545177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545177600000",
    "number": "1356813059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4476 FLEMING ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191284809",
            "telephone_number": "610-724-3284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 E MAIN ST",
            "city": "LANSDALE",
            "state": "PA",
            "postal_code": "194462947",
            "telephone_number": "610-724-3284"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "920 N Broad St Ste 8",
            "address_purpose": "LOCATION",
            "city": "Lansdale",
            "state": "PA",
            "postal_code": "194462318",
            "country_code": "US",
            "telephone_number": "610-724-3284",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ILLINGWORTH",
        "first_name": "CHARLES",
        "middle_name": "BLAINE",
        "name_prefix": "Mr.",
        "name_suffix": "IV",
        "credential": "DIPL.AC., L.AC.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-12-19",
        "last_updated": "2018-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Acupuncturist",
            "state": "PA",
            "license": "AK001285",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Acupuncturist in Lansdale, PA
• Providers in Lansdale, PA by specialty
• Acupuncturist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.