Individual
DR. CHARLES ROBERT PORTWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
310 W LOSEY ST, SCOTT AFB, IL 62225-5250
(618) 256-6267
(618) 256-7931
Mailing address
310 W LOSEY ST, SCOTT AFB, IL 62225-5250
(618) 256-9355
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
6006
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTH000
CHIROPRACTIC PHYSICIAN
IL
Enumeration date
06/01/2006
Last updated
08/07/2024
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