Kyle John Pankonin, DC
Individual provider Active NPI Chiropractor · Lamberton, MN
NPI 1366448276 · NPPES record last updated Jul 12, 2010
Key facts
- NPI
- 1366448276
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- DC3858 (MN)
- Practice address
- 214 Main St
Lamberton, MN 56152-1377 - Phone
- (507) 752-7650
- Fax
- (507) 752-7635
- NPI assigned
- Jun 24, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Northwestern College of Chiropractic, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Red Rock Chiropractic Center LLC
Practice addresses (Care Compare)
202 Main St
Lamberton, MN 56152-0517
Phone (507) 752-7650
202 S Main St
Lamberton, MN 56152-1375
Phone (507) 752-7650
PO Box
Suite 517
Lamberton, MN 56152-0517
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101008000156 | MN | Practitioner - Chiropractic | 2062604010 |
Reassigns benefits to 1 organization Practice locations: Lamberton, MN |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3858 | MN | MD | Marriage & Family Therapist |
| DC3858 | MN | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Red Rock Chiropractic Center LLC | Chiropractor | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC3858 | MN | Yes |
Addresses
Primary practice location
214 Main St
Lamberton, MN 56152-1377
Mailing address
214 Main St
PO Box 517
Lamberton, MN 56152-1377
Phone (507) 752-7650
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 15F52RE | Other | MN | BLUE CROSS BLUE SHIELD |
| 411508205 | Other | MN | HEALTH SERVICES MANAGEMEN |
Other providers in Lamberton, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 12, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.