Basic Information
| Provider Information | |||||||||
| NPI: | 1003018680 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KNOELL | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DC, MHA, CCCSMP, CCI | ||||||||
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| 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 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111NS0005X | 38MC00521600 | NJ | Y | Chiropractic Providers | Chiropractor | Sports Physician | 111NS0005X | 38MC00521600 | TX | N | Chiropractic Providers | Chiropractor | Sports Physician | 111NR0400X | 38MC00521600 | NY | N | Chiropractic Providers | Chiropractor | Rehabilitation | 111NI0013X | 38MC00521600 | TX | N | Chiropractic Providers | Chiropractor | Independent Medical Examiner |
No ID Information.