Provider Demographics
NPI:1043850126
Name:SOARES, MARTIN ANTHONY (DC)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:ANTHONY
Last Name:SOARES
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 1:3638 DELTA FAIR BLVD
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-4006
Mailing Address - Country:US
Mailing Address - Phone:925-777-0808
Mailing Address - Fax:925-777-0899
Practice Address - Street 1:3638 DELTA FAIR BLVD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4006
Practice Address - Country:US
Practice Address - Phone:925-777-0808
Practice Address - Fax:925-777-0899
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC34717111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty