=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336094291
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. LANCE MILLER DC QME PROFESSIONAL CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2026
-----------------------------------------------------
Last Update Date | 03/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3638 DELTA FAIR BLVD
-----------------------------------------------------
City | ANTIOCH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94509-4006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-777-0808
-----------------------------------------------------
Fax | 925-777-0899
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3638 DELTA FAIR BLVD
-----------------------------------------------------
City | ANTIOCH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94509-4006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-777-0808
-----------------------------------------------------
Fax | 925-777-0899
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MARTIN ANTHONY SOARES
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 925-777-0808
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------