Provider Demographics
NPI:1427002781
Name:WILLAFORD, CECIL LANCER (DC)
Entity Type:Individual
Prefix:DR
First Name:CECIL
Middle Name:LANCER
Last Name:WILLAFORD
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:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27596-0309
Mailing Address - Country:US
Mailing Address - Phone:919-556-3333
Mailing Address - Fax:
Practice Address - Street 1:406 US 1 HWY
Practice Address - Street 2:SUITE C
Practice Address - City:YOUNGSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27596-7847
Practice Address - Country:US
Practice Address - Phone:919-556-3333
Practice Address - Fax:919-570-3133
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2956111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085E7Medicaid
NC085E7OtherBCBS ID NUMBER
NC89085E7Medicaid