Provider Demographics
NPI:1942265228
Name:CHLADEK ORTHOTIC & PROSTHETIC ASSOCIATES., INC.
Entity Type:Organization
Organization Name:CHLADEK ORTHOTIC & PROSTHETIC ASSOCIATES., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CERTIFIED ORTHOTIST
Authorized Official - Prefix:
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 1:3005 86TH ST
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-4001
Mailing Address - Country:US
Mailing Address - Phone:515-244-4040
Mailing Address - Fax:515-244-5455
Practice Address - Street 1:3005 86TH ST
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:2006-04-19
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0665703Medicaid
IA0117051Medicaid
IA0665703Medicaid