Organization Active NPI

Alternative Wellness & Chiropractic Center PC

  • Chiropractor
  • Clinton, IA
National Provider Identifier
1750634481
Registry record updated Jul 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
007584 Issued in IA
Legal business name
ALTERNATIVE WELLNESS & CHIROPRACTIC CENTER PC
Practice address
1721 N 2ND St
Clinton, IA 52732-2644
Phone
(563) 242-5515
Fax
(563) 242-0765
NPI assigned
Oct 18, 2012
Last updated
Jul 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2022

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

Authorized official

Name
Dr. Kenneth Daniel Womboldt Jr., B.S., D.C.NPI 1184923690
Title
Chiropractor
Phone
(563) 265-7233

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 007584 IA Primary

Addresses

Primary practice location

1721 N 2ND St
Clinton, IA 52732-2644

Mailing address

1721 N 2ND St
Clinton, IA 52732-2644
Phone (563) 242-5515

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130507000516 IA Part B Supplier - Clinic/Group Practice 7719124916 Receives reassigned benefits from 1 practitioner
Practice locations: Clinton, IA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D2042879Alternative Wellness and Chiropractic Center1721 N 2ND Street, Clinton, IA 52732Certificate of waiverJun 20, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1350518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657584000000",
    "number": "1750634481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1721 N 2ND ST",
            "city": "CLINTON",
            "state": "IA",
            "postal_code": "527322644",
            "telephone_number": "563-242-5515",
            "fax_number": "563-242-0765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 N 2ND ST",
            "city": "CLINTON",
            "state": "IA",
            "postal_code": "527322644",
            "telephone_number": "563-242-5515",
            "fax_number": "563-242-0765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTERNATIVE WELLNESS & CHIROPRACTIC CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-18",
        "last_updated": "2022-07-12",
        "certification_date": "2022-07-12",
        "status": "A",
        "authorized_official_last_name": "WOMBOLDT",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "563-265-7233",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "B.S., D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IA",
            "license": "007584",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.