Individual
MR. CHARLES BLAINE ILLINGWORTH IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DIPL.AC., L.AC.
Contact information
Practice address
601 E MAIN ST, LANSDALE, PA 19446-2947
(610) 724-3284
Mailing address
4476 FLEMING ST, PHILADELPHIA, PA 19128-4809
(610) 724-3284
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AK001285
PA
Other
Enumeration date
12/19/2018
Last updated
12/19/2018
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