NPIMap

Organization Active NPI

Form Health LLC

  • Naturopath
  • Portland, OR
National Provider Identifier
1265605364
Registry record updated Dec 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
NaturopathTaxonomy code 175F00000X
License
1517 Issued in OR
Legal business name
FORM HEALTH LLC
Practice address
8113 SE 13TH Ave
Portland, OR 97202-6607
Phone
(503) 232-5653
NPI assigned
Apr 9, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ryan MinarikNPI 1790829083
Title
Owner
Phone
(503) 232-5653

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
AcupuncturistGroup: 193200000X MULTI-SPECIALTY GROUP 171100000X AC01027 OR
NaturopathGroup: 193200000X MULTI-SPECIALTY GROUP 175F00000X 1517 OR Primary

Addresses

Primary practice location

8113 SE 13TH Ave
Portland, OR 97202-6607

Mailing address

8113 SE 13TH Ave
Portland, OR 97202-6607
Phone (503) 232-5653

National Provider Directory

National Provider Directory

Locations

8113 SE 13th Ave
Portland, OR 97202
Phone (503) 232-5653

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1207699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764720000000",
    "number": "1265605364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8113 SE 13TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972026607",
            "telephone_number": "503-232-5653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8113 SE 13TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972026607",
            "telephone_number": "503-232-5653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORM HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-09",
        "last_updated": "2025-12-03",
        "certification_date": "2025-12-03",
        "status": "A",
        "authorized_official_last_name": "MINARIK",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-232-5653"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": "OR",
            "license": "AC01027",
            "primary": false
        },
        {
            "code": "175F00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Naturopath",
            "state": "OR",
            "license": "1517",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.