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General NPI Number Information
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NPI Number | 1104761980
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Entity Type | Organization
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Legal Business Name | EDEN FAMILY WELLNESS PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/20/2026
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Last Update Date | 04/20/2026
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Provider Practice Location Address
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Address Line | 5331 S MACADAM AVE STE 285
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City | PORTLAND
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State | OR
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Zip | 97239-3849
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Country | US
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Telephone | 971-400-8787
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Fax |
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Provider Business Mailing Address
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Address Line | 1312 SE OLVERA PL
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City | GRESHAM
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State | OR
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Zip | 97080-6187
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Country | US
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Telephone | 971-400-8787
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Fax |
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Authorized Official
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Title or Position | OWNER, CHIROPRACTOR
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Name | DR. AESHA MARIE CARRILLO
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Credential | DC
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Telephone | 971-400-8787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111NP0017X
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Taxonomy Name | Pediatric Chiropractor
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License Number |
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License Number State |
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