NPIMap

Organization Active NPI

Kmgo Enterprises PLLC

Doing business as The Wellness Center Chiropractic

  • Chiropractor
  • Fayetteville, AR
National Provider Identifier
1023828266
Registry record updated Jan 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
KMGO ENTERPRISES PLLC
Doing business as
The Wellness Center Chiropractic
Practice address
1271 Steamboat Dr.
Suite 1
Fayetteville, AR 72704
Phone
(479) 435-6834
Fax
(509) 694-8932
NPI assigned
Jan 9, 2025
Last updated
Jan 9, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kevin Waterloo, DCNPI 1720486699
Title
President / Owner
Phone
(479) 435-6834

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X NU Primary

Addresses

Primary practice location

1271 Steamboat Dr.
Suite 1
Fayetteville, AR 72704

Mailing address

1271 Steamboat Dr.
Suite 1
Fayetteville, AR 72704
Phone (479) 435-6834

Other names 1

  • The Wellness Center Chiropractic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250214001508 AR Part B Supplier - Clinic/Group Practice 8527598911 Receives reassigned benefits from 1 practitioner
Practice locations: Fayetteville, AR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1736380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736380800000",
    "number": "1023828266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1271 STEAMBOAT DR.",
            "address_2": "SUITE 1",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "72704",
            "telephone_number": "479-435-6834",
            "fax_number": "509-694-8932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1271 STEAMBOAT DR.",
            "address_2": "SUITE 1",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "72704",
            "telephone_number": "479-435-6834",
            "fax_number": "509-694-8932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KMGO ENTERPRISES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-09",
        "last_updated": "2025-01-09",
        "certification_date": "2025-01-09",
        "status": "A",
        "authorized_official_last_name": "WATERLOO",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "PRESIDENT / OWNER",
        "authorized_official_telephone_number": "479-435-6834",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Wellness Center Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayetteville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.