Provider Demographics
NPI:1003018680
Name:KNOELL, KYLE A (DC, MHA, CCCSMP, CCI)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:A
Last Name:KNOELL
Suffix:
Gender:M
Credentials:DC, MHA, CCCSMP, CCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-0061
Mailing Address - Country:US
Mailing Address - Phone:732-721-3300
Mailing Address - Fax:732-721-3302
Practice Address - Street 1:540 BORDENTOWN AVE
Practice Address - Street 2:4 FL, SUITE 4900
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879
Practice Address - Country:US
Practice Address - Phone:732-721-3300
Practice Address - Fax:732-721-3302
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00521600111NS0005X
TX38MC00521600111NS0005X, 111NI0013X
NY38MC00521600111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ098381Medicare UPIN
NJ021357U19Medicare UPIN