Provider Demographics
NPI:1922283118
Name:KADLEC
Entity Type:Organization
Organization Name:KADLEC
Other - Org Name:ACTIVE CARE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KADLEC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-426-6063
Mailing Address - Street 1:PO BOX 314
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:SD
Mailing Address - Zip Code:57451-0314
Mailing Address - Country:US
Mailing Address - Phone:605-426-6063
Mailing Address - Fax:605-426-6304
Practice Address - Street 1:615 TH HWY 12
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:SD
Practice Address - Zip Code:57451-0314
Practice Address - Country:US
Practice Address - Phone:605-426-6063
Practice Address - Fax:605-426-6304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1124111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDD01372OtherRAILROAD MEDICARE
SDD01372OtherRAILROAD MEDICARE