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Organization
FORM HEALTH LLC
Active
Organization
FORM HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN MINARIK (OWNER)
(503) 232-5653
Entity
Organization
Contact information
Practice address
8113 SE 13TH AVE, PORTLAND, OR 97202-6607
(503) 232-5653
Mailing address
8113 SE 13TH AVE, PORTLAND, OR 97202-6607
(503) 232-5653
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
AC01027
OR
175F00000X
Naturopath
Primary
1517
OR
Other
Enumeration date
04/09/2008
Last updated
12/03/2025
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