Active NPI
Wildwood Wellness and Rehab LLC
- Chiropractor
- Mahtomedi, MN
National Provider Identifier
1184528697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- Legal business name
- WILDWOOD WELLNESS AND REHAB LLC
- Practice address
- 744 Wildwood Rd
Mahtomedi, MN 55115-1852 - Phone
- (651) 300-3007
- NPI assigned
- Oct 7, 2026
- Last updated
- Oct 7, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Ivan Alejandro Carrillo, DC
- Title
- Owner
- Phone
- (651) 300-3007
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | NU | Primary |
Addresses
Primary practice location
744 Wildwood Rd
Mahtomedi, MN 55115-1852
Mailing address
744 Wildwood Rd
Mahtomedi, MN 55115-1852
Phone (651) 300-3007
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.
-
- Chiropractor
- Mahtomedi, MN
- NPI 1578467080
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1791331200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1791331200000",
"number": "1184528697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "744 WILDWOOD RD",
"city": "MAHTOMEDI",
"state": "MN",
"postal_code": "551151852",
"telephone_number": "651-300-3007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "744 WILDWOOD RD",
"city": "MAHTOMEDI",
"state": "MN",
"postal_code": "551151852",
"telephone_number": "651-300-3007"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WILDWOOD WELLNESS AND REHAB LLC",
"organizational_subpart": "NO",
"enumeration_date": "2026-10-07",
"last_updated": "2026-10-07",
"certification_date": "2026-10-07",
"status": "A",
"authorized_official_last_name": "CARRILLO",
"authorized_official_first_name": "IVAN",
"authorized_official_middle_name": "ALEJANDRO",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "651-300-3007",
"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": []
}Other providers in Mahtomedi, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.