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Individual
DR. KYLE TIMOTHY KOLLBAUM
Active
Individual
DR. KYLE TIMOTHY KOLLBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4077-012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38958400
—
WI
01
—
412011981012
BLUE CROSS BLUE SHIELD
WI
01
—
49D87KO
BLUE CROSS BLUE SHIELD
MN
Enumeration date
06/23/2005
Last updated
01/22/2013
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