Healthcare Provider Details

I. General information

NPI: 1356089379
Provider Name (Legal Business Name): LANCE MILLER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2022
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5670 THE ALAMEDA STE A
BALTIMORE MD
21239-2739
US

IV. Provider business mailing address

PO BOX 69495
BALTIMORE MD
21264-9495
US

V. Phone/Fax

Practice location:
  • Phone: 410-433-5132
  • Fax: 443-977-6106
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JESSICA WHITTEN
Title or Position: BILLING MANAGER
Credential:
Phone: 443-842-5500