Provider Demographics
NPI:1851767735
Name:CHLADEK O & P INC
Entity Type:Organization
Organization Name:CHLADEK O & P INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHLADEK
Authorized Official - Suffix:
Authorized Official - Credentials:BOCP, LP, LO
Authorized Official - Phone:515-244-4040
Mailing Address - Street 1:3007 86TH ST
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322
Mailing Address - Country:US
Mailing Address - Phone:515-244-4040
Mailing Address - Fax:515-244-5455
Practice Address - Street 1:3007 86TH STREET
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-4001
Practice Address - Country:US
Practice Address - Phone:515-244-4040
Practice Address - Fax:515-244-5455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA073991OtherSTATE OF IOWA BOARD OF PODIATRY LICENSE FOR ORTHOTIST
IA073993OtherSTATE OF IOWA BOARD OF PODIATRY LICENSE FOR PROSTHETIST