Organization
KOLLBAUM CHIROPRACTIC LIMITED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KYLE TIMOTHY KOLLBAUM DC (CEO)
(715) 273-3175
Entity
Organization
Contact information
Practice address
430 N MAPLE ST, SUITE 200, ELLSWORTH, WI 54011-9029
(715) 273-3175
(715) 273-3427
Mailing address
430 N MAPLE ST, SUITE 200, ELLSWORTH, WI 54011-9029
(715) 273-3175
(715) 273-3427
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4077012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000035697
MEDICARE
—
05
—
38958400
—
WI
01
—
49D86KO
BCBS MN
MN
01
—
DF7950
MEDICARE RAILROAD
—
Enumeration date
05/31/2007
Last updated
01/22/2013
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