Provider Demographics
NPI:1023828266
Name:KMGO ENTERPRISES PLLC
Entity type:Organization
Organization Name:KMGO ENTERPRISES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WATERLOO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-435-6834
Mailing Address - Street 1:1271 STEAMBOAT DR.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704
Mailing Address - Country:US
Mailing Address - Phone:479-435-6834
Mailing Address - Fax:509-694-8932
Practice Address - Street 1:1271 STEAMBOAT DR.
Practice Address - Street 2:SUITE 1
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704
Practice Address - Country:US
Practice Address - Phone:479-435-6834
Practice Address - Fax:509-694-8932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty