Active NPI
Charles Robert Portwood, D.C.
- Chiropractor
- Scott Afb, IL
National Provider Identifier
1689611576
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 6006
- Practice address
- 310 W Losey St
Scott Afb, IL 62225-5250 - Phone
- (618) 256-6267
- Fax
- (618) 256-7931
- NPI assigned
- Jun 1, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 6006 | MO | Primary |
Addresses
Primary practice location
310 W Losey St
Scott Afb, IL 62225-5250
Mailing address
310 W Losey St
Scott Afb, IL 62225-5250
Phone (618) 256-9355
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OTH000 | Other | IL | CHIROPRACTIC PHYSICIAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6006 | MO | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722988800000",
"number": "1689611576",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "310 W LOSEY ST",
"city": "SCOTT AFB",
"state": "IL",
"postal_code": "622255250",
"telephone_number": "618-256-9355"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "310 W LOSEY ST",
"city": "SCOTT AFB",
"state": "IL",
"postal_code": "622255250",
"telephone_number": "618-256-6267",
"fax_number": "618-256-7931"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORTWOOD",
"first_name": "CHARLES",
"middle_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-01",
"last_updated": "2024-08-07",
"certification_date": "2024-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MO",
"license": "6006",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHIROPRACTIC PHYSICIAN",
"identifier": "OTH000",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Scott Afb, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.