Kyle Timothy Kollbaum, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4077-012 Issued in WI

Practice address

430 N Maple St
Ste 200
Ellsworth, WI 54011-9029

Phone

(715) 273-3175

Fax

(715) 273-3427

NPI assigned

Jun 23, 2005

Last updated

Jan 22, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Specialty

Chiropractic

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Kollbaum Chiropractic Limited

  • Chiropractor
  • Ellsworth, WI
  • NPI 1659572048
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358812800000",
    "number": "1992701056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W4083 490TH AVE",
            "city": "ELLSWORTH",
            "state": "WI",
            "postal_code": "540115823",
            "telephone_number": "715-273-5901",
            "fax_number": "715-273-3427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 N MAPLE ST",
            "address_2": "STE 200",
            "city": "ELLSWORTH",
            "state": "WI",
            "postal_code": "540119029",
            "telephone_number": "715-273-3175",
            "fax_number": "715-273-3427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLLBAUM",
        "first_name": "KYLE",
        "middle_name": "TIMOTHY",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-23",
        "last_updated": "2013-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4077-012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "49D87KO",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38958400",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "412011981012",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Knutson Family Dental
• Kaitlin Knutson, DDS
• Lindsey Kocina
• Amy Alissa Kohls, COTA
• Kollbaum Chiropractic Limited
• Kjrsten Lokker
• Catherine Colette Martin, BSW
• Bridget Marie McConnell, LCSW, LICSW
• Michelle Jean Meinen, CSW
• Richard Allen Moldenhauer, LADC, LPCC,LCADC

• Chiropractor in Ellsworth, WI
• Providers in Ellsworth, WI by specialty
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2013; 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.

Verify at the official NPI Registry.