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General NPI Number Information
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NPI Number | 1891386496
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Entity Type | Individual
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Provider Name | CLINTON WYLIE CAMACHO DC
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Gender | Male
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Dates
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Enumeration Date | 01/27/2021
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Last Update Date | 01/27/2021
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Provider Practice Location Address
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Address Line | 1218 N BONNIE BRAE ST STE 100
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City | DENTON
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State | TX
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Zip | 76201-5487
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Country | US
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Telephone | 940-382-7425
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Fax |
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Provider Business Mailing Address
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Address Line | 4721 CRAWFORD DR
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City | THE COLONY
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State | TX
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Zip | 75056-1617
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Country | US
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Telephone | 940-395-8907
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 14636
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License Number State | TX
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