Basic Information
| Provider Information | |||||||||
| NPI: | 1033661236 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CMP GROUP,PC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | CMP SPINE AND WELNESS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 61 CRANBURY ROAD | ||||||||
| Address2: | |||||||||
| City: | EAST BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7328162345 | ||||||||
| FaxNumber: | 7327213302 | ||||||||
| Practice Location | |||||||||
| Address1: | 540 BORDENTOWN ROAD SUITE 4900 4THFL | ||||||||
| Address2: | |||||||||
| City: | SOUTH AMBOY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327213300 | ||||||||
| FaxNumber: | 7327213302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2016 | ||||||||
| LastUpdateDate: | 11/04/2016 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KNOELL | ||||||||
| AuthorizedOfficialFirstName: | KYLE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7328162345 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CMP GROUP, PC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DC MHA CCSMP CCIC | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111NS0005X | 38MC00521600 | NJ | Y | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor | Sports Physician |
No ID Information.