MEDICARE: EDEN FAMILY WELLNESS PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor
2	111NP0017X	Pediatric Chiropractor

General Provider Information

NPI Number	:	1104761980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDEN FAMILY WELLNESS PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	1312 SE OLVERA PL
Second Line	:
City	:	GRESHAM
State	:	OR
Zip	:	97080-6187
Country	:	US
Telephone Number	:	971-400-8787
Fax Number	:

Provider Business Practice Location Address
First Line	:	5331 S MACADAM AVE STE 285
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-3849
Country	:	US
Telephone Number	:	971-400-8787
Fax Number	:

Authorized Official
Title or Position	:	OWNER, CHIROPRACTOR
Name	:	DR. AESHA MARIE CARRILLO
Credential	:	DC
Telephone Number	:	971-400-8787

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

Similar Medicare Providers

1093650707 — NADJA PRINTUP JONES ELM
Practice Location Address:

5331 S MACADAM AVE STE 287
PORTLAND, OR
97239-3849

Practice Phone: 503-635-3416
Practice Fax:

1801090840 — AMY KILEEN BLACK
Practice Location Address:

5331 S MACADAM AVE STE 287
PORTLAND, OR
97239-3849

Practice Phone: 503-635-3416
Practice Fax:

1992027718 — DR. CRAIG ROMULO GONZALES DC
Practice Location Address:

5331 SW MACADAM AVE STE 285
PORTLAND, OR
97239-3849

Practice Phone: 503-894-9111
Practice Fax: 503-217-6424

1053604496 — MRS. KATHERINE M BALDWIN LMT
Practice Location Address:

5331 SW MACADAM AVE STE 285
PORTLAND, OR
97239-3849

Practice Phone: 503-894-9118
Practice Fax:

1235425505 — MIRIAM L ROBINSON, LICENSED CLINICAL SOCIAL WORKER, LLC
Practice Location Address:

5331 S MACADAM AVE STE 283
PORTLAND, OR
97239-3849

Practice Phone: 503-465-5708
Practice Fax: 503-465-5707

1255753992 — JENNIFER OECHSNER
Practice Location Address:

5331 SW MACADAM AVE STE 285
PORTLAND, OR
97239-3849

Practice Phone: 503-894-9118
Practice Fax:

Directions to “EDEN FAMILY WELLNESS PROFESSIONAL CORPORATION ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.