Provider Demographics
NPI:1659549186
Name:CHLADEK ORTHOTIC & PROSTHETIC ASSOC., INC.
Entity Type:Organization
Organization Name:CHLADEK ORTHOTIC & PROSTHETIC ASSOC., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHLADEK
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:515-244-4040
Mailing Address - Street 1:12871 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8255
Mailing Address - Country:US
Mailing Address - Phone:515-222-1116
Mailing Address - Fax:515-222-0116
Practice Address - Street 1:12871 UNIVERSITY AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8255
Practice Address - Country:US
Practice Address - Phone:515-222-1116
Practice Address - Fax:515-222-0116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0950420002Medicare NSC