Provider Demographics
NPI:1730511189
Name:TLACH, VICTORIA (DC)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:TLACH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4716 HUTCHISON ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-3676
Mailing Address - Country:US
Mailing Address - Phone:847-212-5958
Mailing Address - Fax:
Practice Address - Street 1:1710 W 1ST ST
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-2526
Practice Address - Country:US
Practice Address - Phone:515-964-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007546111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor