Provider Demographics
NPI:1841661758
Name:MINORIK HEALTH AND WELLNESS CENTER INC
Entity type:Organization
Organization Name:MINORIK HEALTH AND WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MINORIK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-607-8464
Mailing Address - Street 1:2620 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-4204
Mailing Address - Country:US
Mailing Address - Phone:330-869-6566
Mailing Address - Fax:330-869-8066
Practice Address - Street 1:2620 W MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-4204
Practice Address - Country:US
Practice Address - Phone:330-869-6566
Practice Address - Fax:330-869-8066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363LF0000X
OH34.007428207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH462620Medicare PIN