Basic Information
Provider Information
NPI: 1003018680
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KNOELL
FirstName: KYLE
MiddleName: A
NamePrefix: DR.
NameSuffix:  
Credential: DC, MHA, CCCSMP, CCI
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 61
Address2:  
City: EAST BRUNSWICK
State: NJ
PostalCode: 088160061
CountryCode: US
TelephoneNumber: 7327213300
FaxNumber: 7327213302
Practice Location
Address1: 540 BORDENTOWN AVE
Address2: 4 FL, SUITE 4900
City: SOUTH AMBOY
State: NJ
PostalCode: 08879
CountryCode: US
TelephoneNumber: 7327213300
FaxNumber: 7327213302
Other Information
ProviderEnumerationDate: 06/05/2007
LastUpdateDate: 12/21/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
111NS0005X38MC00521600TXN Chiropractic ProvidersChiropractorSports Physician
111NS0005X38MC00521600NJY Chiropractic ProvidersChiropractorSports Physician
111NR0400X38MC00521600NYN Chiropractic ProvidersChiropractorRehabilitation
111NI0013X38MC00521600TXN Chiropractic ProvidersChiropractorIndependent Medical Examiner

No ID Information.


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