Active NPI
Kendall A Boline Fenstra, DC
- Chiropractor
- Willmar, MN
National Provider Identifier
1033318415
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 3122
- Practice address
- 1101 S 1St St
Willmar, MN 56201 - Phone
- (320) 235-0515
- NPI assigned
- Jul 16, 2007
- Last updated
- Jun 19, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 3122 | MN | Primary |
Addresses
Primary practice location
1101 S 1St St
Willmar, MN 56201
Mailing address
1101 S 1St St
Willmar, MN 56201
Phone (320) 235-0515
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 900022400 | Medicaid | MN | |
| 3C400B0 | Other | MN | BCBS PROV ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Northwestern College of Chiropractic, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1101 1St S St
Suite 1
Willmar, MN 56201-3500
Phone (320) 235-0515
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3122 | MN | MD | Professional Counselor |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Chiropractor
- Willmar, MN
- NPI 1003075615
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184544000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1434672000000",
"number": "1033318415",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1101 S 1ST ST",
"city": "WILLMAR",
"state": "MN",
"postal_code": "56201",
"telephone_number": "320-235-0515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1101 S 1ST ST",
"city": "WILLMAR",
"state": "MN",
"postal_code": "56201",
"telephone_number": "320-235-0515"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLINE FENSTRA",
"first_name": "KENDALL",
"middle_name": "A",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-16",
"last_updated": "2015-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MN",
"license": "3122",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "900022400",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROV ID",
"identifier": "3C400B0",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Willmar, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.