Provider Demographics
NPI:1538532056
Name:MINTER, CLINTON M (DC)
Entity type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:M
Last Name:MINTER
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 1:711 KIOWA DR W
Mailing Address - Street 2:
Mailing Address - City:LAKE KIOWA
Mailing Address - State:TX
Mailing Address - Zip Code:76240-9597
Mailing Address - Country:US
Mailing Address - Phone:972-215-6406
Mailing Address - Fax:
Practice Address - Street 1:5152 69TH ST STE 101
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-1661
Practice Address - Country:US
Practice Address - Phone:806-794-4009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12930111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor