DR. KRIS BLAINE LASTINE (NPI# 1053403006) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053403006 |
| Entity Type | Individual |
| Full Name | DR. KRIS BLAINE LASTINE |
| Credential | DC |
| Practice Address |
1411 E College Dr Ste 4 Marshall MN 56258 |
| Practice Telephone | 5075371475 |
| Practice Fax Number | 5075379498 |
| Mailing Telephone | 5075371475 |
| Mailing Fax Number | 5075379498 |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2013-04-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | 2194 | MN | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | NEW MEDICARE PROVIDER PTAN # 03/01/2013 | 350005213 | 01 |
| MN | BCBS OF MN | 59611LA | 01 |
| RAILROAD MEDICARE | P00056482 | 01 | |
| MN | 891228900 | 05 |
| Street Address |
1411 E COLLEGE DR STE 4 |
| City | MARSHALL |
| State | MN |
| Zip Code | 56258 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417337874 | Robert Paul Hennen | Chiropractor | 1411 E College Dr, Marshall, MN 56258-2086 | 2015-06-01 |
| 1780078840 | Danielle Regnier | Registered Nurse | 1411 E College Dr, Marshall, MN 56258-2086 | 2015-03-26 |
| 1699169938 | Alyssa Klukas | Registered Nurse | 1411 E College Dr, Marshall, MN 56258-2086 | 2015-03-25 |
| 1821495995 | Randell John Henderson | Registered Nurse | 1411 E College Dr, Marshall, MN 56258-2086 | 2014-12-04 |
| 1376959619 | Jennie Lyn Smith | Registered Nurse | 1411 E College Dr, Marshall, MN 56258-2086 | 2014-07-08 |
| 1205271756 | Jill Marie Jay | Registered Nurse | 1411 E College Dr, Marshall, MN 56258-2086 | 2013-05-09 |
| 1861732844 | Alyssa Chisholm | Registered Nurse | 1411 E College Dr, Marshall, MN 56258-2086 | 2013-02-27 |
| 1477837391 | Lastine Chiropractic PC | Chiropractor | 1411 E College Dr, Ste 4, Marshall, MN 56258-2086 | 2011-10-11 |
| 1902188550 | Sandra Jo Ellingboe | Licensed Practical Nurse | 1411 E College Dr, Marshall, MN 56258-2086 | 2011-09-09 |
| 1518263771 | Laura Rae Roxberg | Registered Nurse | 1411 E College Dr, Marshall, MN 56258-2086 | 2011-02-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285140012 | Action Manufacturing Inc | Durable Medical Equipment & Medical Supplies | 1105 Lake Road, Marshall, MN 56258 | 2017-12-15 |
| 1124579123 | Themarshrx | Durable Medical Equipment & Medical Supplies | 600 Sherman Ave, Marshall, MN 56258 | 2016-10-14 |
| 1780020370 | Heritage Pointe Senio | Assisted Living Facility | 207 N 4th Street, Marshall, MI 56258 | 2013-05-22 |
| 1528351178 | Lori Anne Lynner | Family Medicine | 3160 Us Hwy 59, Marshall, MN 56258 | 2011-05-16 |
| 1912148545 | Tami J Behnke | Counselor | 1418 State Street, Campus Religious Center, Marshall, MN 56258 | 2009-03-11 |
| 1073768396 | Sharyce Marie Audiology Inc | Audiologist | 1424 East College Drive, Suite 200, Marshall, MN 56258 | 2008-12-01 |
| 1497976625 | Erica Anne Jost | Specialist/Technologist | 1501 State Street, Marshall, MN 56258 | 2007-05-02 |
| 1265597470 | Nancy Louise Hemmingson | Optometrist | 300 S Bruce Street, Avera Marshall Southwest Ophthalmology, Marshall, MN 56258 | 2006-12-27 |
| 1407928187 | Midwest Vision Centers Inc | Technician/Technologist | 1113 E College Drive, Marshall, MN 56258 | 2006-11-15 |
| 1306918354 | Paul Joseph Puetz | Chiropractor | 111 Jewett St, Marshall, MN 56258 | 2006-11-14 |
| Find all providers in zip 56258 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720581952 | Jessica Ann Peterson | Chiropractor | 1305 E College Dr Ste B, Marshall, MN 56258-2073 | 2018-03-14 |
| 1780131771 | John Fitzgibbon Memorial Hospital, Inc. | Chiropractor | 2305 South 65 Highway Building A, Marshall, MO 65340-3702 | 2016-09-07 |
| 1447706718 | Kylie Clemons | Chiropractor | 2305 South 65 Hwy, Marshall, MO 65340-3702 | 2016-08-28 |
| 1346624947 | Hennen Chiropractic P.l.l.c. | Chiropractor | 1411 E College Dr Ste 105, Marshall, MN 56258-2086 | 2015-07-13 |
| 1114310257 | Bryan Simpson | Chiropractor | 187 S Lyon Ave, Marshall, MO 65340-1965 | 2015-03-13 |
| 1720351406 | Michael Kern | Chiropractor | 303 S Oconnell St, Marshall, MN 56258-2637 | 2012-02-11 |
| 1285851188 | Wellum Chiropractic Center Inc | Chiropractor | 1602 Illinois Hwy 1, Marshall, IL 62441 | 2007-04-20 |
| 1689898488 | Wilson Chiropractic Clinic | Chiropractor | 2005 E Grand Ave, Marshall, TX 75672 | 2007-04-12 |
| 1417085671 | Lance P Cook | Chiropractor | 201 W Pinecrest Dr, Marshall, TX 75670-7173 | 2007-03-01 |
| 1467590331 | Lockhart Chiropractic, Inc. | Chiropractor | 754 S Odell Ave, Marshall, MO 65340-2504 | 2007-02-02 |
| Find all providers in MARSHALL | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.