Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NI0013X | Independent Medical Examiner | 38MC00521600 | TX |
N | 111NR0400X | Rehabilitation Chiropractor | 38MC00521600 | NY |
Y | 111NS0005X | Chiropractic Sports Physician | 38MC00521600 | NJ |
N | 111NS0005X | Chiropractic Sports Physician | 38MC00521600 | TX |
NPI | 1003018680 |
---|---|
Provider Name | Dr. Kyle A Knoell |
First Address | East Brunswick, NJ 08816-0061 |
Second Address | South Amboy, NJ 08879 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 21/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
021357U19 | (02) | NJ |
098381 | (02) | NJ |