Provider Demographics
NPI:1033661236
Name:CMP GROUP,PC
Entity Type:Organization
Organization Name:CMP GROUP,PC
Other - Org Name:CMP SPINE AND WELNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC MHA CCSMP CCIC
Authorized Official - Phone:732-816-2345
Mailing Address - Street 1:PO BOX 61 CRANBURY ROAD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816
Mailing Address - Country:US
Mailing Address - Phone:732-816-2345
Mailing Address - Fax:732-721-3302
Practice Address - Street 1:540 BORDENTOWN ROAD SUITE 4900 4THFL
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CMP GROUP, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00521600111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty