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General NPI Number Information
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NPI Number | 1275925117
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Entity Type | Organization
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Legal Business Name | ONIK INTEGRATIVE MEDICINE
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Dates
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Enumeration Date | 03/02/2015
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Last Update Date | 03/02/2015
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Provider Practice Location Address
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Address Line | 3300 N BUTLER AVE SUITE 216
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City | FARMINGTON
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State | NM
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Zip | 87401-5621
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Country | US
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Telephone | 505-608-0807
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Fax | 888-868-8946
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Provider Business Mailing Address
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Address Line | 3300 N BUTLER AVE SUITE 216
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City | FARMINGTON
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State | NM
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Zip | 87401-5621
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Country | US
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Telephone | 505-608-0807
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Fax | 888-868-8946
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Authorized Official
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Title or Position | OWNER
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Name | DR. CASEY F ONIK
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Credential | DO
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Telephone | 207-274-8003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1363
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A-1823-14
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License Number State | NM
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