Ivan Alejandro Carrillo, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

7460 Issued in MN

Practice address

744 Wildwood Rd
Mahtomedi, MN 55115-1852

Phone

(651) 300-3007

NPI assigned

Oct 7, 2026

Last updated

Oct 7, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wildwood Wellness and Rehab LLC

  • Chiropractor
  • Mahtomedi, MN
  • NPI 1184528697
  Authorized official Same address or phone

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

{
    "created_epoch": "1791331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791331200000",
    "number": "1578467080",
    "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": {
        "last_name": "CARRILLO",
        "first_name": "IVAN",
        "middle_name": "ALEJANDRO",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-10-07",
        "last_updated": "2026-10-07",
        "certification_date": "2026-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "7460",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Berger Built Construction Co. Inc. (Berger Built Construction)
• Bloom Physical Therapy and Wellness LLC
• Joanell A Bohmert, PT
• Bohn Counseling Associates, Inc,
• Michael David Carlson, MSW, LICSW
• Kaci Ann Carroll, DPT
• Christina Marie Case, LMFT
• Lisa Kerstin Channon I
• Audrey Marie Chaput, OTR/L
• City of Mahtomedi (Mahtomedi Fire Department)

• Chiropractor in Mahtomedi, MN
• Providers in Mahtomedi, MN by specialty
• Chiropractor in Minnesota

• 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.

Verify at the official NPI Registry.