Provider Demographics
NPI:1306878111
Name:MINORIK, GARY J (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:J
Last Name:MINORIK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 W. MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44313
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1639111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0921908Medicaid
OH0921908Medicaid
OHU25360Medicare UPIN