1851767735 NPI number — CHLADEK O & P INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851767735 NPI number — CHLADEK O & P INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHLADEK O & P INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851767735
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3007 86TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
URBANDALE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-244-4040
Provider Business Mailing Address Fax Number:
515-244-5455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3007 86TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
URBANDALE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50322-4001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-244-4040
Provider Business Practice Location Address Fax Number:
515-244-5455
Provider Enumeration Date:
08/14/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CHLADEK
Authorized Official First Name:
JONAS
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
515-244-4040

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 073991 . This is a "STATE OF IOWA BOARD OF PODIATRY LICENSE FOR ORTHOTIST" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 073993 . This is a "STATE OF IOWA BOARD OF PODIATRY LICENSE FOR PROSTHETIST" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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