DR. KYLE TIMOTHY KOLLBAUM (NPI# 1992701056) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1992701056 |
Entity Type | Individual |
Full Name | DR. KYLE TIMOTHY KOLLBAUM |
Credential | D.C. |
Practice Address |
430 N Maple St Ste 200 Ellsworth WI 54011-9029 |
Mailing Address |
W4083 490th Ave Ellsworth WI 54011-5823 |
Practice Telephone | 7152733175 |
Practice Fax Number | 7152733427 |
Mailing Telephone | 7152735901 |
Mailing Fax Number | 7152733427 |
Enumeration Date | 2005-06-23 |
Last Update Date | 2013-01-22 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4077-012 | WI | Chiropractic Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
WI | BLUE CROSS BLUE SHIELD | 412011981012 | 01 |
WI | 38958400 | 05 | |
MN | BLUE CROSS BLUE SHIELD | 49D87KO | 01 |
Street Address |
430 N MAPLE ST STE 200 |
City | ELLSWORTH |
State | WI |
Zip Code | 54011-9029 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1659572048 | Kollbaum Chiropractic Limited | Chiropractor | 430 N Maple St, Suite 200, Ellsworth, WI 54011-9029 | 2007-05-31 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1942864186 | Cb Therapy Group, LLC | Social Worker | 187 E Main Street, Ellsworth, WI 54011 | 2019-04-23 |
1124548201 | Samantha K Johnson | Chiropractor | 187 East Main, Ellsworth, WI 54011 | 2017-06-21 |
1609047869 | Shopko Stores Operating Co LLC | Pharmacy | 598 Lucas Lane, Ellsworth, WI 54011 | 2008-03-17 |
1134301955 | Ellsworth Community School District | Local Education Agency (LEA) | 300 Hillcrest St, Box 1500, Ellsworth, WI 54011 | 2007-12-04 |
1730219239 | Krisan Shaw | Dentist | 501 W. Lucas Lane, Ellsworth, WI 54011 | 2007-03-06 |
1770659658 | Pierce County Dept of Human Services | Community/Behavioral Health | 412 W Kinne Street, Ellsworth, WI 54011 | 2006-11-24 |
1629633912 | Village Pharmacy Healthcare Inc | Pharmacy | 157 E Main St, Ellsworth, WI 54011 | 2019-05-02 |
1396162020 | Shaw Family Dental Sc | Dentist | 501 W. Lucas Lane, Ellsworth, WI 54011 | 2014-03-19 |
1093085680 | Amy Alissa Kohls | Occupational Therapy Assistant | 403 N Maple St, Ellsworth Care Center, Ellsworth, WI 54011 | 2012-01-12 |
1659557510 | Ellsworth Chiropractic Inc | Chiropractor | 187 E Main St, Ellsworth, WI 54011 | 2008-01-10 |
Find all providers in zip 54011 |
Taxonomy Code | 111N00000X |
Grouping | Chiropractic Providers |
Classification | Chiropractor |
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1124548201 | Samantha K Johnson | Chiropractor | 187 East Main, Ellsworth, WI 54011 | 2017-06-21 |
1255889192 | Oak Creek Chiropractic, LLC. | Chiropractor | 519 Prairie Ln, Ellsworth, KS 67439-1504 | 2016-09-20 |
1023181484 | Ronald Scott Nyeggen | Chiropractor | 105 North Piety Street, Ellsworth, WI 54011-0335 | 2006-11-15 |
1578509790 | Gregory Winton Bernard | Chiropractor | 330 West Main Street, Ellsworth, WI 54011-5087 | 2006-06-22 |
1134165855 | Wayne Keith Wallert | Chiropractor | 307 Webb, Ellsworth, KS 67439 | 2006-06-21 |
1295725695 | Alan William Weymouth | Chiropractor | 194 Beechland Rd, Ellsworth, ME 04605-2536 | 2005-10-26 |
1417944430 | Jeffrey Scott Torkelson | Chiropractor | 226 N Douglas Ave, Ellsworth, KS 67439-3208 | 2005-10-04 |
1386117935 | Richard White | Chiropractor | 150 Bucksport Rd, Ellsworth, ME 04605-2224 | 2019-01-07 |
1710456173 | Kyle J Cress | Chiropractor | 330 W Main St, Ellsworth, WI 54011-5087 | 2018-11-15 |
1922540301 | Active Chiropractic and Wellness | Chiropractor | 150 Bucksport Rd, Ellsworth, ME 04605-2224 | 2016-11-16 |
Find all providers in ELLSWORTH |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.