Provider Demographics
NPI:1104050202
Name:LANSFORD, WILLIAM ROBERT (DC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROBERT
Last Name:LANSFORD
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 1:1050 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:NEEDLES
Mailing Address - State:CA
Mailing Address - Zip Code:92363-3815
Mailing Address - Country:US
Mailing Address - Phone:760-326-4414
Mailing Address - Fax:760-326-4419
Practice Address - Street 1:1050 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:NEEDLES
Practice Address - State:CA
Practice Address - Zip Code:92363-3815
Practice Address - Country:US
Practice Address - Phone:760-326-4414
Practice Address - Fax:760-326-4419
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24158111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor