Provider Demographics
NPI:1891386496
Name:CAMACHO, CLINTON WYLIE (DC)
Entity Type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:WYLIE
Last Name:CAMACHO
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 1:4721 CRAWFORD DR
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-1617
Mailing Address - Country:US
Mailing Address - Phone:940-395-8907
Mailing Address - Fax:
Practice Address - Street 1:1218 N BONNIE BRAE ST STE 100
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-5487
Practice Address - Country:US
Practice Address - Phone:940-382-7425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14636111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty