Wildwood Wellness LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

WILDWOOD WELLNESS LLC

Practice address

744 Wildwood Rd
Mahtomedi, MN 55115-1852

Phone

(651) 300-4377

NPI assigned

Aug 2, 2022

Organization subpart

No

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

Authorized official

Name

Josh Hague, DC

Title

Owner

Phone

(651) 249-5170

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joshua J Hague, D.C.

  • Chiropractor
  • Saint Paul, MN
  • NPI 1558375451
  Medicare reassignment NPD
• Hayley Rae Alt, L.AC.

  • Acupuncturist
  • Mahtomedi, MN
  • NPI 1902683782
  NPD

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

{
    "created_epoch": "1659398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659398400000",
    "number": "1730816661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 WARNER AVE S",
            "city": "WILLERNIE",
            "state": "MN",
            "postal_code": "550907702",
            "telephone_number": "651-249-5170"
        },
        {
            "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": "651-300-4377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDWOOD WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-02",
        "last_updated": "2022-08-02",
        "certification_date": "2022-06-13",
        "status": "A",
        "authorized_official_last_name": "HAGUE",
        "authorized_official_first_name": "JOSH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-249-5170",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1538758479",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.wildwoodmn.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "744 Wildwood Rd",
            "city": "Mahtomedi",
            "state": "MN",
            "country_code": "US",
            "postal_code": "551151852",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Amanda Morelan Trnka, LMFT
• Mackenzie Troske Hiatt, EDS, NCSP
• Alexandria Tully, LMFT
• Alexander Michael Voytovich
• Annika Kristin Walker
• Sharla May Woods
• Matthew Mychal Zellmer, PT, DPT, ATR, CSCS

• 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 Aug 2, 2022; 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.