| Organization Name: | EDEN HOLISTIC MEDICINE AND WELLNESS, PC |
| NPI Number: | 1447578117 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KIMBERLEY E JACKSON (PRESIDENT) |
| Mailing Address: | 412 E King St Malvern |
| State: | PA US |
| Postal Code: | 193553004 |
| Phone Number: | 6108338739 |
| Fax Number: | 6106478921 |
| NPI Enumeration Date: | 05/05/2010 |
| NPI Last Update Date: | 05/05/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | OS014960 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |