Provider Demographics
NPI:1992242200
Name:MINOR, CAMOMILLE (LMT)
Entity type:Individual
Prefix:
First Name:CAMOMILLE
Middle Name:
Last Name:MINOR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 S OTIS ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-3443
Mailing Address - Country:US
Mailing Address - Phone:303-945-5876
Mailing Address - Fax:
Practice Address - Street 1:2500 YOUNGFIELD ST
Practice Address - Street 2:SUITE 6
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-1045
Practice Address - Country:US
Practice Address - Phone:303-945-5876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-24
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0010378173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist