Provider Demographics
NPI:1306847975
Name:CHVALA, J ALLEN JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:ALLEN
Last Name:CHVALA
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:705 WARRENVILLE RD
Mailing Address - Street 2:UNIT B
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-6379
Mailing Address - Country:US
Mailing Address - Phone:630-668-8277
Mailing Address - Fax:630-668-3358
Practice Address - Street 1:705 WARRENVILLE RD
Practice Address - Street 2:UNIT B
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-6379
Practice Address - Country:US
Practice Address - Phone:630-668-8277
Practice Address - Fax:630-668-3358
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2008-09-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL162691213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL520883Medicare PIN
ILT36906Medicare UPIN